Early Clinical Application Of The Concept Of Enhanced Recovery After Surgery In Minimally Invasive Mckeown Resection Of Esophageal Cancer

ObjectiveTo analyze the application of the concept of enhanced recovery after surgery(ERAS)in the perioperative management of minimally invasive McKeown resection of esophageal carcinoma,and to explore the effect of the application of this mode in minimally invasive McKeown resection of esophageal carcinoma and its feasibility of later promotion and applicationMethodsThe clinical date of the patients with squamous cell carcinoma confirmed by preoperative pathology from May 2017 to September 2017,treated by single operation group,eliminated operation-related contraindication,underwent minimally invasive McKeown resection of esophageal carcinoma(thoracoscopic and laparoscopic jointly resection of esophagus,gastroesophageal anastomosis in the left neck,two-field lymphadenectomy)were collected.A total of 45 patients of routine management group of single discipline(routine group)from May 2017 to July 2017 were included.The professional committee of ERAS affiliated to the SDPAM(Shandong Association of Pain Medcine,SDAPM)put forward a 20-point improved scheme of perioperative management for the diagnosis and treatment of patients with squamous cell carcinoma in August 2017.And then we applied the scheme to the management of patients with esophageal carcinoma.A total of 57 patients of the multi-discipline group of ERAS(enhanced recovery after surgery,ERAS)from July 2017 to September 2017 were included.Demographic characteristics and clinical data before surgery of the patients were collected including age,gender,BMI,aCCI(age-adjusted Charlson Comorbidity Index,aCCI),ASA grade,tumor location,TNM staging,lymphocyte count and hemoglobin concentration on the second day after admission.The operative time,recovery time after anesthesia,intraoperative blood loss and total amount of intraoperative fluid were collected according to the operation records.According to the results of arterial blood gas analysis 2 hours after the operation,the data of PCO2 of patients was collected.The lymphocyte count(LY)and hemoglobin(HGB)concentration were calculated according to the blood routine examinations on the sixth day after the operation.The overall time from the operation's ending to the first fart and the events of feeding tube displacement were recorded by nursing workers.The VAS(Visual Analogue Scale,VAS)scores of the patients of 6 hours after surgery,the first day after surgery and the third day after surgery,as well as HAMA(Hamilton Anxiety Scale,HAMA)scores of the first day after admission,the first day after surgery and the fifth day after surgery were collected by nurses not involved in this study.The incidence of postoperative complications was recorded.The total length of hospital stay after the operation,hospital deaths,second operation and readmission were also collected.Results1.There were no statistical differences between ERAS group and traditional group inthe data of age,gender,BMI,aCCI,ASA score,tumor location,TNM staging,preoperative lymphocyte count and hemoglobin concentration.2.The operative time and recovery time after general anesthesia in the ERAS group were significantly shorter than that in the conventional group.And the intraoperative fluid was less.There was no statistical difference in intraoperative blood loss between the two groups3.There was no statistical difference in PCO2 two hours after surgery in the ERAS group.And the overall time from operation's ending to the first fart was less than that of the conventional group.The lymphocyte count and hemoglobin concentration of ERAS group on the sixth day after surgery were higher than that of the conventional group.The total length of thoracic drainage and the total length of postoperative hospitalization were shorter than that of the conventional group.The number of patients in the ERAS group who walked for more than 10min on the first day after surgery was higher than that in the conventional group.4.Simultaneous VAS scores at the sixth hour after surgery,on the first day after surgery and the third day after surgery were significantly lower in the ERAS group HAMA score on admission day showed no statistical difference.The ERAS group had lower scores of HAMA on the first day after surgery and the fifth day after surgery than those of traditional group.5.The incidence of pulmonary infection,pharyngalgia,sacrococcygeal skin damage and diarrhea was lower in ERAS group.The incidence of postoperative feeding tube displacement was lower in the ERAS group6.In this study,there was no statistical difference in the data of hospital deaths,second operation and readmission.ConclusionsIt is safe and feasible to apply the concept of ERAS to minimally invasive Mckeown resection of esophageal carcinoma,which can effectively reduce postoperative pain and postoperative anxiety of patients,accelerate the improvement of normally physiological function,reduce the incidence of postoperative complications and shorten the length of hospitalization.