From the *Department of Anesthesiology, Virginia Mason Medical Center; †Axio Research; and ‡Department of General Thoracic Surgery, Virginia Mason Medical Center, Seattle, WA.
Reg Anesth Pain Med. 2015 Mar-Apr;40(2):139-49. doi: 10.1097/AAP.0000000000000197.
Esophageal cancer is a leading cause of cancer death worldwide, and esophageal resection is associated with extremely high perioperative morbidity and mortality. A perioperative clinical pathway for esophagectomy patients in which anesthetic care is both integral and standardized has not been described previously.
A continuously refined clinical pathway for perioperative care of the esophagectomy patient has been developed at the Virginia Mason Medical Center over the past 22 years. Ongoing data collection records patient demographics, comorbidities, tumor stage, and various outcomes including intensive care unit and hospital length of stay, surgical complications, and morbidity and mortality rates.
Over time, patients presenting for surgical treatment of esophageal cancer have had significantly higher Charlson comorbidity scores and a higher incidence of diabetes mellitus, hypertension, liver disease, and history of deep vein thrombosis or pulmonary embolism. During the same period, intensive care unit and hospital length of stays have decreased, whereas most complication rates have remained stable despite more advanced tumor stage and increased use of neoadjuvant chemoradiotherapy. In-hospital and 30-day mortality rates are well below national averages at 0.5% each.
We present a detailed anesthetic and surgical perioperative pathway for esophageal resection, along with evidence of improved or stable patient outcomes despite an increase in comorbidity burden and increasingly advanced tumor stage.
食管癌是全球主要的癌症死因，食管切除术与极高的围手术期发病率和死亡率相关。以前尚未描述过一种将麻醉护理作为整体和标准化的食管癌切除术患者围手术期临床路径。
在过去的 22 年中，弗吉尼亚梅森医疗中心不断完善了食管癌患者围手术期护理的临床路径。持续的数据收集记录了患者的人口统计学特征、合并症、肿瘤分期以及包括重症监护病房和住院时间、手术并发症、发病率和死亡率在内的各种结果。
随着时间的推移，接受手术治疗食管癌的患者的 Charlson 合并症评分显著升高，糖尿病、高血压、肝病、深静脉血栓形成或肺栓塞病史的发生率也更高。在此期间，重症监护病房和住院时间缩短，尽管肿瘤分期更晚且新辅助放化疗的应用增加，但大多数并发症发生率仍保持稳定。院内和 30 天死亡率分别为 0.5%，远低于全国平均水平。
我们提出了一种详细的麻醉和手术围手术期路径，尽管合并症负担增加且肿瘤分期越来越晚，但患者的预后仍得到改善或保持稳定。
