[Strategy and prospective of enhanced recovery after surgery for esophageal cancer].
Enhanced recovery after surgery (ERAS) is a patient-centered, surgeon-led system combining anesthesia, nursing, nutrition and psychology. It aims to minimize surgical stress and maintain physiological function in perioperative care, thereby expediting recovery. ERAS theory has been clinically applied for nearly 20 years and it is firstly used in colorectal surgery, then widely used in other surgical fields. However, ERAS is not used commonly in esophagectomy because of its surgical complexity and high morbidity of postoperative complications, which limits the application of ERAS in the field of esophagectomy. In recent years, with the increasing maturation of minimally invasive esophagectomy, attention to tissue and organ protection concept, improvement of making gastric tube, breakthrough of anastomosis technique, and the presentation and application of new concepts, ERAS has made great progress in the field of esophagectomy. This article summarizes some ERAS measures in the treatment of esophageal cancer based on evidence-based medicine, and performs an effective ERAS mode for clinical application of esophagectomy. During preoperative preparation and evaluation, we propose preoperative education and nutrition evaluation without regular intestinal preparation, and advocate preemptive analgesia without preanesthetic medication. During intra-operative management, anesthesia scheme should be optimized, fluid transfusion should be controlled properly, suitable operation mode should be chosen, and intraoperative hypothermia should be avoided. During postoperative management, sufficient analgesia should be administered with non-opioid analgesics, drainage tube placement must be decreased and removed earlier, urinary catheter and gastrointestinal decompression tube should be removed earlier, and oral intake and ambulation should be resumed as early as possible. "Received surgery yesterday, oral intake today, discharged home 5-7 days", ERAS program based on "non tube no fasting" has been applied in some medical centers and becomes more and more maturation. In the future, we will rely on the increasing improvement and systemic training of ERAS mode in order to promote such application in more medical centers. With the multi-center clinical trials, based on constant enrichments and improvements, a general expert consensus will be made finally.
Department of Thoracic Surgery, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China. liyin825@aliyun.com.
Yin
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Li
D000698:Analgesia / Q000379:methods; D000768:Anesthesia, General / Q000379:methods; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods; D004322:Drainage / Q000295:instrumentation / Q000379:methods; D004938:Esophageal Neoplasms / Q000534:rehabilitation* / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods* / Q000523:psychology / Q000534:rehabilitation*; D019317:Evidence-Based Medicine; D005248:Feeding Methods; D006801:Humans; D007902:Length of Stay; D019060:Minimally Invasive Surgical Procedures / Q000379:methods* / Q000534:rehabilitation*; D009752:Nutritional Status; D010353:Patient Education as Topic / Q000379:methods; D019990:Perioperative Care / Q000379:methods*; D014546:Urinary Catheterization / Q000379:methods; D016138:Walking