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A prospective randomized controlled trial (RCT) of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer.This study evaluates the use of a multimodal package in colorectal cancer surgery in the context of an RCT.Patients for elective resection for colorectal cancer were offered trial entry. Participants were stratified by sex and requirement for a total mesorectal excision and centrally randomized. Multimodal patients received intravenous fluid restriction, unrestricted oral intake with prokinetic agents, early ambulation, and fixed regimen epidural analgesia. Control patients received intravenous fluids to prevent oliguria, restricted oral intake until return of bowel motility, and weaning regimen epidural analgesia. Adherence to both regimens was reinforced using a daily checklist and protocol guidance sheets. Discharge decision was made using pre-agreed criteria. The primary endpoint was postoperative stay, and achievement of independence milestones. Secondary endpoints were postoperative complications, readmission rates, and mortality. Analysis was by intention to treat.Seventy patients were recruited. Approximately one fourth underwent TME. Median ages were similar (69.3 vs. 73.0 years). The median stay was significantly reduced in the multimodal group (5 vs. 7 days; P0.001, Mann-Whitney U test). Patients in the control arm were 2.5 times as likely to require a postoperative stay of more than 5 days. Patients in the multimodal group had less cardiorespiratory and anastomotic complications but more readmissions. There were 2 deaths, both controls.This RCT provides level 1b evidence that a multimodal management protocol can significantly reduce postoperative stay following colorectal cancer surgery. Morbidity and mortality are not increased.

STUDY DESIGN A retrospective report of three cases outlining upper intestinal obstruction as a rare complication following surgery for scoliosis. OBJECTIVE To present the clinical features, progression, and management of duodenal obstruction due to superior mesenteric artery compression after surgical treatment of scoliosis. SUMMARY OF BACKGROUND DATA Superior mesenteric artery or cast syndrome has been reported historically in the literature. Many causes are described, among which is the complication of the surgical and nonoperative treatment of scoliosis. METHODS Three adolescent patients were investigated for nausea and vomiting following surgical correction of scoliosis. RESULTS Contrast radiography confirmed extrinsic obstruction of the third part of the duodenum by the superior mesenteric artery in all three patients. They were jointly managed with the gastrointestinal surgeons. Two patients recovered with conservative treatments, but the third required operative intervention with a laparotomy. CONCLUSIONS Vomiting following surgery for scoliosis should be investigated thoroughly, as superior mesenteric artery syndrome carries significant morbidity, protracted hospital stay, and potential mortality.