Division of Thoracic Surgery, McGill University Health Centre, Montreal, QC, Canada.
Faculty of Medicine, The Royal College of Surgeons in Ireland, Dublin, Ireland.
Ann Surg Oncol. 2021 Sep;28(9):4850-4858. doi: 10.1245/s10434-021-09854-7. Epub 2021 Mar 27.
We have previously demonstrated that implementing an enhanced recovery protocol (ERP) improved outcomes after esophagectomy. We sought to examine if, after a decade of an established ERP, further improvements in postoperative outcomes could be made after continually optimizing and revising the pathway.
Patients undergoing esophagectomy for cancer from January 2019 to January 2020 were compared with our early-experience group within the initial ERP (June 2010-May 2011) and pre-ERP traditional care (June 2009-May 2010). The original ERP was initiated on June 2010 and underwent several revisions from 2014 to 2018, incorporating the following, amongst other elements: shorten the planned length of stay from 7 to 6 days, elimination of nasogastric tubes, use of soft closed-suction chest drains, and increased application of minimally invasive esophagectomy (MIE). Thirty-day outcomes (complications, length of stay, readmission) were compared for patients undergoing esophagectomy during the initial and most recent ERPs.
Overall, 175 patients were identified; 47 underwent esophagectomy before ERP implementation (traditional care), 59 patients underwent esophagectomy after implementation of the original ERP, and 69 patients underwent esophagectomy after the most recent ERP (ERP 2.0). The groups were similar with respect to age, sex, and diagnosis. There were three times more MIEs in the ERP 2.0 group with a shorter median length of stay (7 [6-9] vs. 8 [7-17] vs. 10 [9-17]; p < 0.001) without impacting postoperative morbidity or readmission rate.
Continued evaluation of institutional outcomes after esophagectomy should be performed to identify target areas for optimization and revision of established enhanced recovery protocols. ERPs are dynamic processes that can be further refined to yield greater improvements in outcomes.
我们之前已经证明，实施强化康复方案（ERP）可以改善食管癌手术后的结果。我们试图研究在 ERP 建立十年后，通过不断优化和修改路径，是否可以进一步改善术后结果。
将 2019 年 1 月至 2020 年 1 月期间接受食管癌手术的患者与我们在初始 ERP （2010 年 6 月至 2011 年 5 月）和 ERP 前传统治疗（2009 年 6 月至 2010 年 5 月）期间的早期经验组进行比较。原始 ERP 于 2010 年 6 月启动，并在 2014 年至 2018 年期间进行了多次修订，其中包括将计划住院时间从 7 天缩短至 6 天、取消鼻胃管、使用软闭式胸腔引流管以及增加微创食管切除术（MIE）的应用。比较接受初始和最新 ERP 期间进行的食管癌手术患者的 30 天结果（并发症、住院时间、再入院）。
总共确定了 175 名患者；47 名患者在 ERP 实施前（传统治疗）接受了食管癌手术，59 名患者在原始 ERP 实施后接受了食管癌手术，69 名患者在最近的 ERP （ERP 2.0）后接受了食管癌手术。各组在年龄、性别和诊断方面相似。在 ERP 2.0 组中，MIE 增加了三倍，中位住院时间更短（7 [6-9] vs. 8 [7-17] vs. 10 [9-17]；p<0.001），而不会影响术后发病率或再入院率。
应继续评估食管癌手术后的机构结果，以确定优化和修订既定强化康复方案的目标领域。ERP 是一个动态的过程，可以进一步改进，以进一步改善结果。
