直腸・骨盤手術のERASガイドライン

直腸・骨盤手術に対するERASのガイドライン論文を紹介します。

J. Nygren, et al. Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clinical Nutrition, http://dx.doi.org/10.1016/j.clnu.2012.08.012

ERASを構成している各項目について、そのエビデンスと推奨度を示しています。ERASに関しては、「キーワードでわかる臨床栄養」で寺島先生が詳しく解説しています。

http://www.nutri.co.jp/nutrition/keywords/ch8-2/

結果ですが、ほとんどの項目でエビデンスのレベルは高いから中等度となっています。ただし、早期離床に関してはエビデンスレベルは低いという結果です。上記の寺島先生の執筆にもあるように、早期離床のエビデンスは意外と乏しいです。早期離床のエビデンスを作ることも重要だと改めて感じます。

Summary

Background

This review aims to present a consensus for optimal perioperative care in rectal/pelvic surgery, and to provide graded recommendations for items for an evidenced-based enhanced recovery protocol.

Methods

Studies were selected with particular attention paid to meta-analyses, randomized controlled trials and large prospective cohorts. For each item of the perioperative treatment pathway, available English-language literature was examined, reviewed and graded. A consensus recommendation was reached after critical appraisal of the literature by the group.

Results

For most of the protocol items, recommendations are based on good-quality trials or meta-analyses of good-quality trials (evidence grade: high or moderate).

Conclusions

Based on the evidence available for each item of the multimodal perioperative care pathway, the Enhanced Recovery After Surgery (ERAS) Society, European Society for Clinical Nutrition and Metabolism (ESPEN) and International Association for Surgical Metabolism and Nutrition (IASMEN) present a comprehensive evidence-based consensus review of perioperative care for rectal surgery.