食道がん術後のERAS

食道がん術後のERASに関する後ろ向きコホート研究を紹介します。

Cao S, Zhao G, Cui J, Dong Q, Qi S, Xin Y, Shen B, Guo Q. Fast-track rehabilitation program and conventional care after esophagectomy: a retrospective controlled cohort study. Support Care Cancer. 2012 Aug 30. [Epub ahead of print]

ERAS（早期リハプログラム）の内容は、早期離床・運動、硬膜外疼痛管理、静脈栄養での水分管理と経管栄養です。結果ですが、ERASのほうが入院期間の中央値と、術後1カ月以内の合併症発生割合が有意に低かったです。疼痛管理もERASのほうが満足度が高かったです。

以上より食道がん術後のERASは有用という結論です。ただ、RCTではなく後ろ向きコホート研究ですので、今後RCTでの検証は必要だろうと思います。従来型のケアがどの程度かによっても差は変わりますし。

Abstract

PURPOSE:

The purpose of this article is to evaluate fast-track rehabilitation program and conventional care after esophagectomy using a retrospective controlled cohort study in esophageal cancer patients.

METHODS:

Fifty-five patients underwent fast-track rehabilitation program and 57 patients underwent conventional care after esophagectomy. Fast-track rehabilitation program was performed to patients who have early movement, epidural analgesia control, fluid infusion volume control and enteral nutrition for early discharge. The other 57 patients underwent conventional care after esophagectomy. The average of hospital stay and complications were calculated in the patients between the two groups.

RESULTS:

The median length of hospital stay in the patients was significantly shorter after fast-track rehabilitation program than after conventional care (7.7 vs 14.8 day, P < 0.01). The percentage of patients who developed complications was significantly lower 30 day after fast-track rehabilitation program than after conventional care (29.1 vs 47.4 %, P < 0.05). 87.3 % in patients of the fast-track rehabilitation program group and 54.4 % in those of the conventional care group reported excellent to very good satisfaction with their pain control (P = 0.000).

CONCLUSIONS:

The fast-track rehabilitation program results in fewer complications, less postoperative pain, a reduction in the hospital length of stay, and quicker return to work and normal activities after esophagectomy.