Taniguchi Hideki, Sasaki Toshio, Fujita Hisae, Kobayashi Hiroko, Kawasaki Rieko, Ogata Takashi, Cho Haruhiko, Yoshikawa Takaki, Ushigome Keiko, Tanaka Akemi, Takano Osami
Department of Nutrition, Faculty of Human Services, Kanagawa University of Human Services, 1-10-1 Heisei, Yokosuka, Kanagawa 238-8522, Japan.
Department of Anaesthesiology, Kanagawa Cancer Centre, 2-3-2 Nakao, Asahi-Ku, Yokohama, Kanagawa 241-8515, Japan.
Clin Nutr ESPEN. 2018 Feb;23:184-193. doi: 10.1016/j.clnesp.2017.10.002. Epub 2017 Nov 7.
The Enhanced Recovery after Surgery (ERAS) program has been proposed as a postoperative recovery-enhancing strategy. We frequently apply the Modified-ERAS program following oesophagectomy. This study aims to elucidate the impact of goal-directed fluid therapy (GDT) for the perioperative management of oesophageal cancer on the postoperative recovery of patients undergoing oesophagectomy.
This is an interventional before-after comparative observational study conducted at Kanagawa Cancer Centre, Japan. Patients who underwent elective oesophagectomy for oesophageal cancer were recruited. Group H (retrospectively collected) received intraoperative and postoperative management consisting of fluid administration without haemodynamic monitoring and the M-ERAS program, while Group S prospectively received management consisting of GDT and the M-ERAS program. The primary endpoint was the speed of gastrointestinal functional recovery, while secondary endpoints were the level of postoperative mobilisation, incidence of complications, postoperative length of hospital stay (LOS), and nutritional status after discharge.
The proportion of patients who completely egested Gastrografin by postoperative day 4, the level of postoperative mobilisation, and achievement ratio for a 100-m walk on the first postoperative attempt were significantly higher in Group S than in Group H (P = 0.034, P = 0.0197, and P < 0.0001, respectively). No significant differences were observed in the postoperative LOS and incidence of complications within 30 days between the groups. The serum albumin levels at 6 months after discharge was higher in Group S than in Group H (P = 0.0002).
The GDT-ERAS program enhanced postoperative gastrointestinal recovery and mobilisation, as well as postoperative nutritional status and protein synthesis. The program did not affect either postoperative LOS or the incidence of complications.
UMIN registration number: UMIN000013705, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000015999.
手术加速康复（ERAS）方案已被提出作为一种促进术后恢复的策略。我们在食管癌切除术后经常应用改良的ERAS方案。本研究旨在阐明目标导向液体治疗（GDT）在食管癌围手术期管理中对接受食管癌切除术患者术后恢复的影响。
这是一项在日本神奈川县癌症中心进行的干预前后对比观察性研究。招募了因食管癌接受择期食管癌切除术的患者。H组（回顾性收集）接受术中及术后管理，包括无血流动力学监测的液体输注和M-ERAS方案，而S组前瞻性地接受由GDT和M-ERAS方案组成的管理。主要终点是胃肠功能恢复速度，次要终点是术后活动水平、并发症发生率、术后住院时间（LOS）以及出院后的营养状况。
S组术后第4天完全排出泛影葡胺的患者比例、术后活动水平以及术后首次尝试100米步行的完成率均显著高于H组（分别为P = 0.034、P = 0.0197和P < 0.0001）。两组之间术后LOS和30天内并发症发生率无显著差异。S组出院后6个月时的血清白蛋白水平高于H组（P = 0.0002）。
GDT-ERAS方案可促进术后胃肠恢复和活动能力，以及术后营养状况和蛋白质合成。该方案对术后LOS和并发症发生率均无影响。
UMIN注册号：UMIN000013705，https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000015999 。
