Nursing Department, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450008, China.
Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450000, China.
Support Care Cancer. 2022 Jun;30(6):5027-5036. doi: 10.1007/s00520-022-06924-8. Epub 2022 Feb 22.
Perioperative rehabilitation management is essential to enhanced recovery after surgery (ERAS). Limited reports, however, have focused on quantitative, detailed early activity plans for patients receiving minimally invasive esophagectomy (MIE). The purpose of this research was to estimate the effectiveness of the Tailored, Early Comprehensive Rehabilitation Program (t-ECRP) based on ERAS in the recovery of bowel and physical functions for patients undergoing MIE.
In this single-blind, 2-arm, parallel-group, randomized pilot clinical trial, patients admitted to the Affiliated Cancer Hospital of Zhengzhou University from June 2019 to February 2020 were selected and randomly assigned to an intervention group (IG) or a control group (CG). The participants in the IG received medical care based on the t-ECRP strategy during perioperative period, and participants in the CG received routine care. The recovery of bowel and physical functions, readiness for hospital discharge (RHD), and postoperative hospital stay were evaluated on the day of discharge.
Two hundred and fifteen cases with esophageal cancer (EC) were enrolled and randomized to the IG (n = 107) or CG (n = 108). The mean age was 62.58 years (SD 9.07) and 71.16% were male. For EC, 53.49% were mid-location cancers and 79.07% were classified as pathological stage II and III cancers. There were no significant differences between the two groups in terms of demographic and clinical characteristics and baseline physical functions. Participants in the IG group presented significantly shorter lengths of time to first flatus (P < 0.001), first postoperative bowel movement (P = 0.024), and for up and go test (P < 0.001), and lower scores of frailty (P < 0.001). The analysis also showed that participants in the IG had higher scores of RHD and shorter lengths of postoperative stay than in the CG (P < 0.05).
The t-ECRP appears to improve bowel and physical function recovery, ameliorate RHD, and shorten postoperative hospital stay for patients undergoing MIE. Clinicians should consider prescribing quantitative, detailed, and individualized early activity plans for these patients.
ClinicalTrials.gov (Identifier: NCT01998230).
围手术期康复管理对于手术后的加速康复至关重要。然而，有限的报道集中在接受微创食管切除术（MIE）的患者的定量、详细的早期活动计划上。本研究的目的是评估基于加速康复外科（ERAS）的个体化、早期综合康复方案（t-ECRP）在 MIE 患者肠功能和体力恢复方面的效果。
这是一项单盲、2 臂、平行组、随机临床试验，选择 2019 年 6 月至 2020 年 2 月期间郑州大学附属肿瘤医院收治的患者，并将其随机分为干预组（IG）或对照组（CG）。IG 组患者在围手术期接受 t-ECRP 策略的医疗护理，CG 组患者接受常规护理。在出院当天评估肠功能和体力恢复、出院准备度（RHD）和术后住院时间。
共纳入 215 例食管癌（EC）患者，随机分为 IG（n=107）或 CG（n=108）。平均年龄为 62.58 岁（标准差 9.07），71.16%为男性。对于 EC，53.49%为中段癌，79.07%为病理分期 II 期和 III 期癌症。两组在人口统计学和临床特征以及基线体力功能方面无显著差异。IG 组患者首次排气（P<0.001）、首次术后排便（P=0.024）和起立行走测试（P<0.001）的时间明显缩短，虚弱评分（P<0.001）降低。分析还显示，IG 组患者的 RHD 评分较高，术后住院时间较短（P<0.05）。
t-ECRP 似乎可以改善 MIE 患者的肠功能和体力恢复，改善 RHD，并缩短术后住院时间。临床医生应为这些患者开具定量、详细、个体化的早期活动计划。
ClinicalTrials.gov（标识符：NCT01998230）。
