| Abstrakt: |
Background We introduced a multiprofessional fast track programme in esophagectomy in order to increase surgical safety and to reduce the perioperative burden to the patient. Methods Consecutive patients scheduled for oncological Hybrid Ivor Lewis (HIL) procedure were included. An adapted ERAS protocol beginning from the process of preoperative risk estimation involving internists, oncologists, physiotherapists, psychologists, dietricians, surgeons and anesthesiologists to make patients fit for surgery. In locally advanced tumor stages neoadjuvant treatment was adopted according to interdisciplinary consensus. Perioperative measures were undertaken to enhance recovery and to reduce morbidity by an adopted ERAS protocol. Parameters regarding surgical safety, oncological quality of surgery, duration of hospital stay, unplanned readmissions and survival were recorded. Results Since 2014 94 patients underwent esophageal resection. Among them 80 had an Ivor Lewis procedure, 69 patients (female, 16; mean age, 66a) underwent HIL for cancer. The majority received neoadjuvant treatment before HIL (chemotherapy, 47; radiochemotherapy, 10). R-0 rate was 92,8%, mean number of examined lymphnodes was 33,5. Major morbidity (Clavien-Dindo III-V) occurred in 13,04%, anastomotic leaks in 7,2%, 8 (11,6%) patients underwent redo surgery. 6 (8,7%) patients needed prolonged mechanical ventilation. Hospital, 30d- and 90d-mortality was 2.9, 2.9 and 4,3%, respectively. Median hospital stay was 12 days (8–57) in all patients and 26 days (14–57) in patients with major morbidity. Unplanned readmission occurred in 7,2%. Overall, ERAS protocol was fulfilled in 66,7% of cases. Estimated 2-year overall survival is 82%. Conclusion Adopting an ERAS protocol with dedicated interprofessional perioperative care operative safety compares favourably with other reports. Performing the abdominal part endoscopically does not impair surrogate parameters of oncological quality. However, length of hospital stay seems to be optimizable. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR] |
