Hideki Taniguchi1, Toshio Sasaki2, Hisae Fujita2, Hiroko Kobayashi2, Rieko Kawasaki2, Takashi Ogata3, Haruhiko Cho3, Takaki Yoshikawa3, Keiko Ushigome4, Akemi Tanaka4, Osami Takano2. 1. Department of Nutrition, Faculty of Human Services, Kanagawa University of Human Services, 1-10-1 Heisei, Yokosuka, Kanagawa 238-8522, Japan. Electronic address: hstani@aol.jp. 2. Department of Anaesthesiology, Kanagawa Cancer Centre, 2-3-2 Nakao, Asahi-Ku, Yokohama, Kanagawa 241-8515, Japan. 3. Department of Gastrointestinal Surgery, Kanagawa Cancer Centre, 2-3-2 Nakao, Asahi-Ku, Yokohama, Kanagawa 241-8515, Japan. 4. Department of Nutrition, Faculty of Human Services, Kanagawa University of Human Services, 1-10-1 Heisei, Yokosuka, Kanagawa 238-8522, Japan.
Abstract
BACKGROUND AND AIMS: The Enhanced Recovery after Surgery (ERAS) program has been proposed as a postoperative recovery-enhancing strategy. We frequently apply the Modified-ERAS program following oesophagectomy. This study aims to elucidate the impact of goal-directed fluid therapy (GDT) for the perioperative management of oesophageal cancer on the postoperative recovery of patients undergoing oesophagectomy. METHODS: This is an interventional before-after comparative observational study conducted at Kanagawa Cancer Centre, Japan. Patients who underwent elective oesophagectomy for oesophageal cancer were recruited. Group H (retrospectively collected) received intraoperative and postoperative management consisting of fluid administration without haemodynamic monitoring and the M-ERAS program, while Group S prospectively received management consisting of GDT and the M-ERAS program. The primary endpoint was the speed of gastrointestinal functional recovery, while secondary endpoints were the level of postoperative mobilisation, incidence of complications, postoperative length of hospital stay (LOS), and nutritional status after discharge. RESULTS: The proportion of patients who completely egested Gastrografin by postoperative day 4, the level of postoperative mobilisation, and achievement ratio for a 100-m walk on the first postoperative attempt were significantly higher in Group S than in Group H (P = 0.034, P = 0.0197, and P < 0.0001, respectively). No significant differences were observed in the postoperative LOS and incidence of complications within 30 days between the groups. The serum albumin levels at 6 months after discharge was higher in Group S than in Group H (P = 0.0002). CONCLUSIONS: The GDT-ERAS program enhanced postoperative gastrointestinal recovery and mobilisation, as well as postoperative nutritional status and protein synthesis. The program did not affect either postoperative LOS or the incidence of complications. TRIAL REGISTRATION: UMIN registration number: UMIN000013705, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000015999.
BACKGROUND AND AIMS: The Enhanced Recovery after Surgery (ERAS) program has been proposed as a postoperative recovery-enhancing strategy. We frequently apply the Modified-ERAS program following oesophagectomy. This study aims to elucidate the impact of goal-directed fluid therapy (GDT) for the perioperative management of oesophageal cancer on the postoperative recovery of patients undergoing oesophagectomy. METHODS: This is an interventional before-after comparative observational study conducted at Kanagawa Cancer Centre, Japan. Patients who underwent elective oesophagectomy for oesophageal cancer were recruited. Group H (retrospectively collected) received intraoperative and postoperative management consisting of fluid administration without haemodynamic monitoring and the M-ERAS program, while Group S prospectively received management consisting of GDT and the M-ERAS program. The primary endpoint was the speed of gastrointestinal functional recovery, while secondary endpoints were the level of postoperative mobilisation, incidence of complications, postoperative length of hospital stay (LOS), and nutritional status after discharge. RESULTS: The proportion of patients who completely egested Gastrografin by postoperative day 4, the level of postoperative mobilisation, and achievement ratio for a 100-m walk on the first postoperative attempt were significantly higher in Group S than in Group H (P = 0.034, P = 0.0197, and P < 0.0001, respectively). No significant differences were observed in the postoperative LOS and incidence of complications within 30 days between the groups. The serum albumin levels at 6 months after discharge was higher in Group S than in Group H (P = 0.0002). CONCLUSIONS: The GDT-ERAS program enhanced postoperative gastrointestinal recovery and mobilisation, as well as postoperative nutritional status and protein synthesis. The program did not affect either postoperative LOS or the incidence of complications. TRIAL REGISTRATION: UMIN registration number: UMIN000013705, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000015999.
Authors: Thais O Polanco; Meghana G Shamsunder; Madeleine E V Hicks; Kenneth P Seier; Kay See Tan; Sabine Oskar; Joseph H Dayan; Joseph J Disa; Babak J Mehrara; Robert J Allen; Jonas A Nelson; Anoushka M Afonso Journal: J Plast Reconstr Aesthet Surg Date: 2021-02-04 Impact factor: 3.022
Authors: M F Boekel; C S Venema; T Kaufmann; I C C van der Horst; J J Vos; T W L Scheeren Journal: J Clin Monit Comput Date: 2020-09-12 Impact factor: 1.977