Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan.
Department of Gastroenterological Surgery, Kansai Rosai Hospital, Amagasaki, Japan.
Anticancer Res. 2023 Sep;43(9):4197-4205. doi: 10.21873/anticanres.16611.
BACKGROUND/AIM: The enhanced recovery after surgery (ERAS) program is expected to improve perioperative outcomes in patients with esophageal cancer. However, how ERAS impacts the postoperative body composition and factors related to compliance rate of ERAS have not been fully investigated.
The study included 252 consecutive patients with thoracic esophageal cancer who underwent minimally invasive esophagectomy. We compared the postoperative outcomes including body composition between the old perioperative program and the new one that aimed to shorten postoperative length of stay (LOS). Compliance-related clinical factors were also examined.
From 252 patients, 129 underwent the old program and 123 the new program. Postoperative LOS, postoperative complications, and hospital costs were reduced with the new program. Body weight loss was significantly improved with the new program at discharge and 3-months after esophagectomy (94.9% vs. 96.6%, p=0.013, 89.5% vs. 91.1%, p=0.028, respectively). Patients in the new program had better body composition at discharge than those in the old program [body fat mass (91.6% vs. 94.1%), lean body mass (95.2% vs. 97.2), and skeletal muscle mass (95.3% vs. 97.0%)]. Major reasons for incompliance were dysphagia, pneumonia, and anastomotic leakage. Multivariate analysis revealed that age ≥70 years at surgery and sex (male) were independent risk factors for incompliance with the postoperative program.
The new ERAS program aimed to shorten postoperative LOS had clinical benefits in body composition early after esophagectomy. Personalized ERAS programs based on age might lead to better postoperative outcomes because of low compliance rates for older patients.
背景/目的：术后加速康复（ERAS）方案有望改善食管癌患者的围手术期结局。然而，ERAS 如何影响术后身体成分以及与 ERAS 依从率相关的因素尚未得到充分研究。
本研究纳入了 252 例接受微创食管切除术的胸段食管癌患者。我们比较了新旧围手术期方案的术后结局，包括身体成分。同时还检查了与依从性相关的临床因素。
252 例患者中，129 例行旧方案，123 例行新方案。新方案缩短了术后住院时间（LOS），降低了术后并发症和住院费用。新方案在出院时和食管切除术后 3 个月时体重减轻明显改善（94.9%比 96.6%，p=0.013，89.5%比 91.1%，p=0.028）。与旧方案相比，新方案患者在出院时的身体成分更好[体脂量（91.6%比 94.1%）、去脂体重（95.2%比 97.2%）和骨骼肌量（95.3%比 97.0%）]。不依从的主要原因是吞咽困难、肺炎和吻合口漏。多变量分析显示，手术时年龄≥70 岁和性别（男性）是术后方案不依从的独立危险因素。
旨在缩短术后 LOS 的新 ERAS 方案在食管切除术后早期具有改善身体成分的临床益处。基于年龄的个体化 ERAS 方案可能会因老年患者依从率低而导致更好的术后结局。
