Department of Surgery, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3695, Japan.
Department of Rehabilitation Medicine, Iwate Medical University School of Medicine, Iwate, Japan.
Esophagus. 2021 Jan;18(1):56-64. doi: 10.1007/s10388-020-00757-2. Epub 2020 Jul 1.
Several studies have demonstrated that prehabilitation helps reduce the incidence of postoperative complications. In this study, we investigated the safety and efficacy of enhanced prehabilitation (EP) in the hospital for patients with esophageal cancer.
We retrospectively reviewed the data of 48 consecutive patients who underwent radical esophagectomy with gastric tube reconstruction between September 2015 and June 2019. EP program had been introduced in August 2017. In the EP group, patients received the EP program during hospitalization 7 days before surgery in addition to conventional perioperative rehabilitation. The EP program consisted of aerobic exercise and muscle strength training in the morning and afternoon. Operative outcomes were compared between patients who received EP (EP group; 23 patients) and patients who did not receive EP (control group; 25 patients).
The preoperative (EP group vs. control group, 492.9 ± 79.7 vs. 418.9 ± 71.8 m, p < 0.001) and postoperative (EP group vs. control group, 431.5 ± 80 vs. 378 ± 68.7 m, p < 0.001) 6-min walk distance was significantly higher in the EP group than in the control group. The respiratory complications rate was significantly lower in the EP group (4.3%) than in the control group (36%) (p = 0.007). The incidence of atelectasis was particularly significantly lower in the EP group (0%) than in the control group (24%) (p = 0.012).
EP was performed safely for patients before esophagectomy. EP improved the exercise tolerance of the patients before esophagectomy and might be useful in preventing respiratory complications.
多项研究表明，术前康复有助于降低术后并发症的发生率。本研究旨在探讨增强型术前康复（EP）在食管癌患者住院期间的安全性和有效性。
我们回顾性分析了 2015 年 9 月至 2019 年 6 月期间 48 例接受根治性食管切除术和胃管重建术的连续患者的数据。2017 年 8 月引入 EP 方案。在 EP 组中，患者在手术前 7 天在医院接受 EP 方案治疗，同时接受常规围手术期康复。EP 方案包括上午和下午的有氧运动和肌肉力量训练。比较接受 EP（EP 组；23 例）和未接受 EP（对照组；25 例）的患者的手术结果。
EP 组患者术前（EP 组 vs. 对照组，492.9±79.7 vs. 418.9±71.8 m，p<0.001）和术后（EP 组 vs. 对照组，431.5±80 vs. 378±68.7 m，p<0.001）6 分钟步行距离明显高于对照组。EP 组患者呼吸系统并发症发生率明显低于对照组（4.3% vs. 36%，p=0.007）。EP 组患者肺不张发生率明显低于对照组（0% vs. 24%，p=0.012）。
EP 方案在食管癌患者术前安全实施。EP 方案提高了患者术前的运动耐量，可能有助于预防呼吸系统并发症。
