Abstract
Purpose
The purpose of this article is to evaluate fast-track rehabilitation program and conventional care after esophagectomy using a retrospective controlled cohort study in esophageal cancer patients.
Methods
Fifty-five patients underwent fast-track rehabilitation program and 57 patients underwent conventional care after esophagectomy. Fast-track rehabilitation program was performed to patients who have early movement, epidural analgesia control, fluid infusion volume control and enteral nutrition for early discharge. The other 57 patients underwent conventional care after esophagectomy. The average of hospital stay and complications were calculated in the patients between the two groups.
Results
The median length of hospital stay in the patients was significantly shorter after fast-track rehabilitation program than after conventional care (7.7 vs 14.8 day, P < 0.01). The percentage of patients who developed complications was significantly lower 30 day after fast-track rehabilitation program than after conventional care (29.1 vs 47.4 %, P < 0.05). 87.3 % in patients of the fast-track rehabilitation program group and 54.4 % in those of the conventional care group reported excellent to very good satisfaction with their pain control (P = 0.000).
Conclusions
The fast-track rehabilitation program results in fewer complications, less postoperative pain, a reduction in the hospital length of stay, and quicker return to work and normal activities after esophagectomy.
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References
Kehlet H, Mogensen T (1999) Hospital stay of 2 days after open sigmoidectomy with a multimodal rehabilitation programme. Br J Surg 86(2):227–230. doi:10.1046/j.1365-2168.1999.01023.x
Cerfolio RJ, Bryant AS, Bass CS, Alexander JR, Bartolucci AA (2004) Fast tracking after Ivor Lewis esophagogastrectomy. Chest 126(4):1187–1194. doi:10.1378/chest.126.4.1187
Jiang K, Cheng L, Wang JJ, Li JS, Nie J (2009) Fast track clinical pathway implications in esophagogastrectomy. World J Gastroenterol 15(4):496–501
Sica GS, Sujendran V, Wheeler J, Soin B, Maynard N (2005) Needle catheter jejunostomy at esophagectomy for cancer. J Surg Oncol 91(4):276–279. doi:10.1002/jso.20314
Olsen MF, Wennberg E (2011) Fast-track concepts in major open upper abdominal and thoracoabdominal surgery: a review. World J Surg 35(12):2586–2593. doi:10.1007/s00268-011-1241-1
Brodner G, Pogatzki E, Van Aken H, Buerkle H, Goeters C, Schulzki C, Nottberg H, Mertes N (1998) A multimodal approach to control postoperative pathophysiology and rehabilitation in patients undergoing abdominothoracic esophagectomy. Anesth Analg 86(2):228–234
Munitiz V, Martinez-de-Haro LF, Ortiz A, Ruiz-de-Angulo D, Pastor P, Parrilla P (2010) Effectiveness of a written clinical pathway for enhanced recovery after transthoracic (Ivor Lewis) oesophagectomy. Br J Surg 97(5):714–718. doi:10.1002/bjs.6942
Kehlet H, Wilmore DW (2008) Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 248(2):189–198. doi:10.1097/SLA.0b013e31817f2c1a
Qadan M, Gardner SA, Vitale DS, Lominadze D, Joshua IG, Polk HC Jr (2009) Hypothermia and surgery: immunologic mechanisms for current practice. Ann Surg 250(1):134–140. doi:10.1097/SLA.0b013e3181ad85f7
Leslie K, Sessler DI (2003) Perioperative hypothermia in the high-risk surgical patient. Best Pract Res Clin Anaesthesiol 17(4):485–498
Kurz A, Sessler DI, Lenhardt R (1996) Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med 334(19):1209–1215. doi:10.1056/NEJM199605093341901
Lobo DN, Bostock KA, Neal KR, Perkins AC, Rowlands BJ, Allison SP (2002) Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial. Lancet 359(9320):1812–1818. doi:10.1016/S0140-6736(02)08711-1
Nisanevich V, Felsenstein I, Almogy G, Weissman C, Einav S, Matot I (2005) Effect of intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology 103(1):25–32
Kita T, Mammoto T, Kishi Y (2002) Fluid management and postoperative respiratory disturbances in patients with transthoracic esophagectomy for carcinoma. J Clin Anesth 14(4):252–256
Neal JM, Wilcox RT, Allen HW, Low DE (2003) Near-total esophagectomy: the influence of standardized multimodal management and intraoperative fluid restriction. Reg Anesth Pain Med 28(4):328–334
Langley SM, Alexiou C, Bailey DH, Weeden DF (2002) The influence of perioperative blood transfusion on survival after esophageal resection for carcinoma. Ann Thorac Surg 73(6):1704–1709
Swisher SG, Holmes EC, Hunt KK, Gornbein JA, Zinner MJ, McFadden DW (1996) Perioperative blood transfusions and decreased long-term survival in esophageal cancer. J Thorac Cardiovasc Surg 112(2):341–348
Lanuti M, de Delva PE, Maher A, Wright CD, Gaissert HA, Wain JC, Donahue DM, Mathisen DJ (2006) Feasibility and outcomes of an early extubation policy after esophagectomy. Ann Thorac Surg 82(6):2037–2041. doi:10.1016/j.athoracsur.2006.07.024
Bartels H, Stein HJ, Siewert JR (1998) Early extubation vs. late extubation after esophagus resection: a randomized, prospective study. Langenbecks Arch Chir Suppl Kongressbd 115:1074–1076
Daryaei P, Vaghef Davari F, Mir M, Harirchi I, Salmasian H (2009) Omission of nasogastric tube application in postoperative care of esophagectomy. World J Surg 33(4):773–777. doi:10.1007/s00268-009-9930-8
Nguyen NT, Slone J, Wooldridge J, Smith BR, Reavis KM, Hoyt D (2009) Minimally invasive esophagectomy without the use of postoperative nasogastric tube decompression. Am Surg 75(10):929–931
Pettigrew RA, Hill GL (1986) Indicators of surgical risk and clinical judgement. Br J Surg 73(1):47–51
Ogus H, Selimoglu O, Basaran M, Ozcelebi C, Ugurlucan M, Sayin OA, Kafali E, Ogus TN (2007) Effects of intrapleural analgesia on pulmonary function and postoperative pain in patients with chronic obstructive pulmonary disease undergoing coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 21(6):816–819. doi:10.1053/j.jvca.2007.05.002
Lunardi AC, Cecconello I, Carvalho CR (2011) Postoperative chest physical therapy prevents respiratory complications in patients undergoing esophagectomy. Rev Bras Fisioter 15(2):160–165
Abramov D, Yeshayahu M, Tsodikov V, Gatot I, Orman S, Gavriel A, Chorni I, Tuvbin D, Tager S, Apelbom A (2005) Timing of chest tube removal after coronary artery bypass surgery. J Card Surg 20(2):142–146. doi:10.1111/j.0886-0440.2005.200347.x
Lewis SJ, Egger M, Sylvester PA, Thomas S (2001) Early enteral feeding versus “nil by mouth” after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. BMJ 323(7316):773–776
Hjort Jakobsen D, Sonne E, Basse L, Bisgaard T, Kehlet H (2004) Convalescence after colonic resection with fast-track versus conventional care. Scand J Surg 93(1):24–28
Tsui SL, Law S, Fok M, Lo JR, Ho E, Yang J, Wong J (1997) Postoperative analgesia reduces mortality and morbidity after esophagectomy. Am J Surg 173(6):472–478
Rudin A, Flisberg P, Johansson J, Walther B, Lundberg CJ (2005) Thoracic epidural analgesia or intravenous morphine analgesia after thoracoabdominal esophagectomy: a prospective follow-up of 201 patients. J Cardiothorac Vasc Anesth 19(3):350–357
Michelet P, D'Journo XB, Roch A, Papazian L, Ragni J, Thomas P, Auffray JP (2005) Perioperative risk factors for anastomotic leakage after esophagectomy: influence of thoracic epidural analgesia. Chest 128(5):3461–3466. doi:10.1378/chest.128.5.3461
Acknowledgments
The authors would like to acknowledge the assistance of Dr. Jianjun Wang and others for their assistance in establishing the fast-track rehabilitation program protocol. Financial support for this study was provided by Science Foundation of Heilongjiang Health Department and China Postdoctoral Science Foundation.
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The authors declare no conflict of interest.
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Cao, S., Zhao, G., Cui, J. et al. Fast-track rehabilitation program and conventional care after esophagectomy: a retrospective controlled cohort study. Support Care Cancer 21, 707–714 (2013). https://doi.org/10.1007/s00520-012-1570-0
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DOI: https://doi.org/10.1007/s00520-012-1570-0