Zhou et al. BMC Cancer 2011, 11:494 http://www.biomedcentral.com/1471-2407/11/494 Data collection and monitoring All the data will be collected by assigned persons: the information of surgery and perioperative treatment will be collected during hospitalization, and the information of chemotherapy will be followed up. A professional research associate develops regular contact between the study centers and monitors the information for each patient. Discussion As we know, the surgery, perioperative treatment and chemotherapy for colorectal cancer stretches roughly to half a year at present, which means a long hospital stay for the patients and high medical resource costs. As a result, two demand-oriented feasible methods have been brought into the colorectal cancer treatment, laparoscopic surgery and fast-track perioperative treatment. For laparoscopic surgery, the COST Study Group trial has proved the advantages of laparoscopy for colon can- cer, especially in faster perioperative recovery and shorter hospital stays, with the similar recurrence and overall survival rates to the open-colectomy group [1]. The UK MRC CLASICC Trial also demonstrated that laparoscopy-colectomy is as effective as open surgery in terms of oncological outcomes [30]. For Fast-track peri- operative treatment, the LAFA Study Group and ERAS Group presented a systematic evidence-based consensus review, proving that Fast Track treatment appears to be safe and can shorten the hospital stay after elective col- orectal surgery [9]. All the studies above provided the feasibility and safety of both laparoscopic surgery and fast-track perioperative treatment. However, it is important to point out that, the enhanced recovery mentioned in current study about laparoscopy and Fast-track, is confined to the short- term postoperative recovery, which only lasts 1-2 weeks perioperatively. The previous study showed that quality of life benefits due to minimally invasive laparoscopic surgery were evident only in the immediate postopera- tive period [31]. As a result, the long-term benefit relies on the innovative treatment model covering not only surgery but also adjuvant chemotherapy. It’s significant and interesting to investigate whether it will be possible to cover the enhanced recovery over the whole colorec- tal cancer treatment and how it works. Consequently, combining the long-term benefit chemotherapy treat- ment is taken into consideration. The NO16968/XELOXA study discovered that the Xelox chemotherapy used as an adjuvant chemotherapy for colorectal cancer become possible now, as it has a manageable tolerability profile in adjuvant setting [17]. In each cycle of Xelox chemotherapy, there is only 1 day hospital stay for intravenous Oxaliplatin and the Page 8 of 10 Capecitabine intake from 1st to14th day can be done in home. And in mFolfox6 chemotherapy, each cycle needs 3 days hospital stay in China. Consequently, it can be seen clearly that the superiority of Xelox for shorter hospital stay with the similar Overall Survival (OS) to mFolfox6. On this consideration, before this trial, KF Ding has been conducting an open nonrandomized prospective study comparing laparoscopic surgery with Xelox che- motherapy and open surgery with mFolfox6 chemother- apy for resectable colorectal cancer, and the interim analysis has proved that the former provides faster post- operative recovery and potentially sustained better qual- ity of life throughout treatment [32]. In the view of the separate superiority of the laparo- scopy, Fast-track perioperative treatment and Xelox che- motherapy, and the possibility of the integration of these three essential treatments in colorectal cancer, the new notion “Fast Track Multi-Discipline Treatment” (FTMDT) for the integration of these three treatments is promoted in this FTMDT trial. And this FTMDT model is supposed to substantially reduce the length of hospital stays with equal safety and effectiveness, gain the better long-term recovery outcomes, and give patients a better quality of life. The 2 × 2 balanced factorial design for this rando- mized prospective controlled FTMDT study tries to answer 2 corresponding questions. The I and II groups versus the III and IV groups is designed to answer the research question “Is Fast-track multidiscipline treat- ment model safe and effective, compared to conven- tional treatment?”, while the I group versus II group aims to answer “Is laparoscopy an essential component of FTMDT-trial and how important role does it play?” It’s necessary to mention that, the second question about the necessity of laparoscopy use is closely related to the treatment cost. On one hand, the use of laparo- scopy itself will increase the operation cost, compared to the open operation; on the other hand, the shorter hospital stay if the laparoscopy could bring, will conver- sely bring the reduction of the treatment cost. It is still unknown whether laparoscopic surgery has a beneficial effect on Fast-track perioperative treatment, although the most recent studies have proved that the laparo- scopic surgery with Fast-track treatment also has shorter hospital stay and enhanced recovery [22-26]. However, research has found that there is no further benefit for the laparoscopy, compared with open surgery groups, and even with the two groups both using Fast-track perioperative treatment [33-35]. And some trials are still undergoing now to try to answer the question, like LAFA-trial which is now being conducted in Nether- lands [36]. Consequently, it can be assumed that, if the laparoscopy did not play the essential role in enhanced