Nguyen Yen-Lan, Maiolino Elena, De Pauw Vincent, Prieto Mathilde, Mazzella Antonio, Peretout Jean-Baptiste, Dechartres Agnès, Baillard Christophe, Bobbio Antonio, Daffré Elisa, Alifano Marco
Anesthesiology and Critical Care Medicine Department, Cochin Academic Hospital, APHP, Université de Paris, 75014 Paris, France.
Thoracic Surgical Department, Cochin Academic Hospital, APHP, Université de Paris, 75014 Paris, France.
Cancers (Basel). 2022 Mar 29;14(7):1745. doi: 10.3390/cancers14071745.
In spite of increasing diffusion, Enhanced Recovery Pathways (ERP) have been scarcely assessed in large scale programs of lung cancer surgery. The aim of this study was auditing our practice.
A two-step audit program was established: the first dealing with our initial ERP experience in patients undergoing non-extended anatomical segmentectomies and lobectomies, the second including all consecutive patients undergoing all kind of lung resections for NSCLC. The first step aimed at auditing results of ERP on occurrence of postoperative complications and at assessing which ERP components are associated with improved short-term outcomes. We also audited late results by assessing long-term survival of patients in the first step of our study. The second step aimed at auditing on large-scale short-term results of the ERP in a real-life setting.
Over a one-year period, 166 patients were included. The median number of ERP procedures per patient was three (IQR 3-4). No postoperative death occurred. The overall adverse events rate was 30%. In multivariate analyzes, the only element associated with reduced adverse postoperative events was chest tube withdrawal within POD2 (OR = 0.21, 95% CI (0.10-0.46)). The 1-, 3-, and 5-year survival rates were 97%, 86.1%, and 76.3%, respectively. In the second period, 1077 patients were included in our ERP; 11 patients died during the postoperative period or within 30 days of operation (1.02%). The overall postoperative adverse event rate was 30.3%, major complication occurring in 134 (12.4%), and minor ones in 192 (17.8%). Respiratory complications occurred in 64 (5.9%). Thoracoscore independently predicted postoperative death, the occurrence of complications (all-kind, minor, major, or respiratory ones).
Compliance to ERP procedures and early chest tube removal are associated with reduced postoperative events in patients with lung resection surgery. In a large setting scale, ERP can be applied with satisfactory results in terms of mortality and morbidity. Thoracoscore is a useful tool in predicting mortality and postoperative adverse events.
尽管强化康复路径（ERP）的应用日益广泛，但在大规模肺癌手术项目中对其评估甚少。本研究旨在审核我们的实践情况。
制定了一个两步审核方案：第一步针对我们在接受非扩大性解剖性肺段切除术和肺叶切除术患者中的初始ERP经验，第二步纳入所有接受各种NSCLC肺切除术的连续患者。第一步旨在审核ERP对术后并发症发生情况的影响，并评估哪些ERP组成部分与改善短期结局相关。我们还通过评估研究第一步中患者的长期生存率来审核远期结果。第二步旨在审核ERP在实际环境中的大规模短期结果。
在一年时间里，共纳入166例患者。每位患者的ERP程序中位数为3次（四分位间距3 - 4）。未发生术后死亡。总体不良事件发生率为30%。在多变量分析中，与术后不良事件减少相关的唯一因素是术后第2天内拔除胸管（比值比 = 0.21，95%置信区间(0.10 - 0.46)）。1年、3年和5年生存率分别为97%、86.1%和76.3%。在第二阶段，1077例患者纳入我们的ERP；11例患者在术后期间或术后30天内死亡（1.02%）。总体术后不良事件发生率为30.3%，主要并发症发生在134例（12.4%），次要并发症发生在192例（17.8%）。呼吸并发症发生在64例（5.9%）。胸科手术评分独立预测术后死亡、并发症（各类、轻微、严重或呼吸相关并发症）的发生。
遵守ERP程序和早期拔除胸管与肺切除手术患者术后事件减少相关。在大规模应用中，ERP在死亡率和发病率方面应用效果令人满意。胸科手术评分是预测死亡率和术后不良事件的有用工具。
