Division of Gastrointestinal Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
Esophagus. 2021 Jul;18(3):537-547. doi: 10.1007/s10388-021-00823-3. Epub 2021 Feb 18.
Implementation of enhanced recovery after surgery has generally been applied to gastrointestinal surgeries; however, few studies have investigated minimally invasive McKeown esophagectomy. In this study, we aimed to evaluate the safety and feasibility of an enhanced recovery protocol after minimally invasive McKeown esophagectomy.
Data were collected between January 2015 and April 2020 for patients who underwent esophagectomy. Of these patients, those who underwent minimally invasive McKeown esophagectomy was selected for the investigation. Perioperative outcomes and nutritional index were compared using propensity score matching between the conventional group and the enhanced recovery group.
A total of 119 patients were enrolled in this study. Of these, 73 and 46 were treated with conventional and enhanced recovery protocol, respectively. Forty-two pairs were matched in two groups. The enhanced recovery group showed a lower rate of pulmonary complications (9.5% vs. 28.5%, p = 0.0235), abdominal dysfunctions (16.7% vs. 42.9%, p = 0.0078), and shorter hospital stay as compared with the conventional group (17.5 days vs. 23 days, p = 0.0034). The loss of body weight (6.3% vs. 7.7%, p = 0.0065) and body mass index (5.6% vs. 8.1%, p = 0.0017) were significantly lower in the enhanced recovery group than in the conventional group. In contrast, nutritional biochemistry data did not differ significantly between the two groups.
This study shows that the promotion of an enhanced recovery protocol in minimally invasive McKeown esophagectomy maintains nutritional status without increasing postoperative complications.
加速康复外科（ERAS）方案通常应用于胃肠外科，但微创 McKeown 食管切除术的相关研究较少。本研究旨在评估微创 McKeown 食管切除术后应用 ERAS 方案的安全性和可行性。
回顾性分析 2015 年 1 月至 2020 年 4 月期间行食管切除术的患者资料。根据手术方式，选取微创 McKeown 食管切除术患者进行研究。通过倾向评分匹配比较常规组和加速康复组的围手术期结局和营养指标。
本研究共纳入 119 例患者，其中微创 McKeown 食管切除术患者 73 例（常规组），加速康复组 46 例。两组各匹配 42 对。与常规组相比，加速康复组的肺部并发症发生率（9.5% vs. 28.5%，p=0.0235）、腹部并发症发生率（16.7% vs. 42.9%，p=0.0078）和术后住院时间（17.5 天 vs. 23 天，p=0.0034）均较低。加速康复组患者的体重丢失（6.3% vs. 7.7%，p=0.0065）和 BMI 丢失（5.6% vs. 8.1%，p=0.0017）也明显低于常规组。两组患者的营养生化指标差异无统计学意义。
微创 McKeown 食管切除术后应用 ERAS 方案可维持患者的营养状态，不增加术后并发症。
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