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Zentralbl Chir 2021; 146(03): 306-314
DOI: 10.1055/a-1487-7086
Übersicht

Fast-Track-Rehabilitation nach Ösophagektomie

Fast-track Rehabilitation after Oesophagectomy
Wolfgang Schroeder
Klinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinikum Köln, Deutschland
,
Christoph Mallmann
Klinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinikum Köln, Deutschland
,
Benjamin Babic
Klinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinikum Köln, Deutschland
,
Christiane Bruns
Klinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinikum Köln, Deutschland
,
Hans Friedrich Fuchs
Klinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinikum Köln, Deutschland
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Zusammenfassung

Das multimodale und interprofessionelle Konzept der Fast-Track-Rehabilitation (Synonym: „enhanced recovery after surgery“, ERAS) ist bei der transthorakalen Ösophagektomie grundsätzlich umsetzbar, weist aber im Gegensatz zur Fast-Track-Chirurgie anderer onkologischer Prozeduren 2 wesentliche Besonderheiten auf. Aufgrund der hohen Komorbidität der Patienten mit Ösophaguskarzinom ist das Fast-Track-Konzept ein Teilaspekt des perioperativen Managements und von der präoperativen Konditionierung einzelner Organdysfunktionen (Prähabilitation) nicht zu trennen. Da die gastrale Rekonstruktion eine hohe Prävalenz eines „delayed gastric conduit emptying“ (DGCE) bedingt, ist postoperativ ein frühzeitiger und kalorisch adäquater, oraler Kostaufbau nur eingeschränkt durchführbar. Einen allgemein akzeptierten Algorithmus zum postoperativen Ernährungsmanagement und zur Prophylaxe/Therapie des DGCE gibt es gegenwärtig nicht. Die in spezialisierten Zentren bereits niedrige Mortalität wird durch das Fast-Track-Programm nicht beeinflusst. Ob die postoperative Morbidität mit diesem Konzept gesenkt wird, kann durch die gegenwärtige Studienlage nicht abschließend beantwortet werden. Nach modifizierter Fast-Track-Rehabilitation ist eine Entlassung aus der stationären Behandlung ab dem 8. postoperativen Tag bei unkompliziertem Verlauf möglich.

Abstract

The multimodal and interprofessional concept of fast-track rehabilitation (“enhanced recovery after surgery”, ERAS) is generally applicable to transthoracic oesophagectomy, but is associated with two special features as compared to other oncological procedures. Due to the high comorbidity of oesophageal cancer patients, fast-track pathways have to be considered as one component of perioperative management and cannot be separated from prehabilitation with preoperative conditioning of single organ dysfunctions. Since gastric reconstruction causes a high prevalence of delayed gastric conduit emptying (DGCE), early and sufficient postoperative oral feeding is not easily feasible. There is currently no generally accepted algorithm for the postoperative nutritional management as well as for the prophylaxis/treatment of DGCE. Fast-track prehabilitation does not influence the mortality rate in specialised centres. At present, it is not clear whether a fast-track pathway helps to reduce postoperative morbidity. After modified fast-track rehabilitation, hospital discharge is possible from the 8th postoperative day.

Schlüsselwörter

Fast-Track Rehabilitation - Ösophagektomie - Prähabilitation - perioperatives Management

Key words

fast-track rehabilitation - esophagectomy - prehabilitation - perioperative management


Publication History

Article published online:
21 June 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Booka E, Takeuchi H, Suda K. et al. Meta-analysis of the impact of postoperative complications on survival after oesophagectomy for cancer. BJS Open 2018; 2: 276-284
    CrossrefPubMedSearch in Google Scholar
  • 2 Mamidanna R, Bottle A, Aylin P. et al. Short-Term Outcomes Following Open Versus Minimally Invasive Esophagectomy for Cancer in England. Ann Surg 2012; 255: 197-203
    CrossrefPubMedSearch in Google Scholar
  • 3 Messager M, Pasquer A, Duhamel A. et al. Laparoscopic gastric mobilization reduces postoperative mortality after esophageal cancer surgery: A French nationwide study. Ann Surg 2015; 262: 817-823
    CrossrefPubMedSearch in Google Scholar
  • 4 Nimptsch U, Haist T, Gockel I. et al. Complex gastric surgery in Germany–is centralization beneficial? Observational study using national hospital discharge data. Langenbecks Arch Surg 2019; 404: 93-101
    CrossrefPubMedSearch in Google Scholar
  • 5 Fuchs HF, Harnsberger CR, Broderick RC. et al. Simple preoperative risk scale accurately predicts perioperative mortality following esophagectomy for malignancy. Dis Esophagus 2017; 30: 1-6
    CrossrefPubMedSearch in Google Scholar
  • 6 Moran J, Guinan E, McCormick P. et al. The ability of prehabilitation to influence postoperative outcome after intra-abdominal operation: A systematic review and meta-analysis. Surgery 2016; 160: 1189-1201
    CrossrefPubMedSearch in Google Scholar
  • 7 Haverkamp L, Seesing MFJ, Ruurda JP. et al. Worldwide trends in surgical techniques in the treatment of esophageal and gastroesophageal junction cancer. Dis Esophagus 2017; 30: 1-7
    CrossrefPubMedSearch in Google Scholar
  • 8 Schwenk W. Fast-Track-Rehabilitation. In: Schwenk W, Freys SM, Calff JC. Hrsg. Perioperative Medizin. Stuttgart: Thieme; 2017: 511-514
    Search in Google Scholar
  • 9 Chen L, Sun L, Lang Y. et al. Fast-track surgery improves postoperative clinical recovery and cellular and humoral immunity after esophagectomy for esophageal cancer. BMC Cancer 2016; 16: 449
    CrossrefPubMedSearch in Google Scholar
  • 10 Low DE, Allum W, De Manzoni G. et al. Guidelines for Perioperative Care in Esophagectomy: Enhanced Recovery After Surgery (ERAS®) Society Recommendations. World J Surg 2019; 43: 299-330
    CrossrefPubMedSearch in Google Scholar
  • 11 Mallmann C, Drinhaus H, Fuchs H. et al. Perioperatives “Enhanced-recovery-after-surgery”-Programm der Ivor-Lewis-Ösophagektomie. Chirurg 2021; 92: 158-167
    CrossrefPubMedSearch in Google Scholar
  • 12 Low DE, Kuppusamy MK, Alderson D. et al. Benchmarking Complications Associated with Esophagectomy. Ann Surg 2019; 269: 291-298
    CrossrefPubMedSearch in Google Scholar
  • 13 Schmidt HM, Gisbertz SS, Moons J. et al. Defining Benchmarks for Transthoracic Esophagectomy. Ann Surg 2017; 266: 814-821
    CrossrefPubMedSearch in Google Scholar
  • 14 Porschen R, Fischbach W, Gockel I. et al. S3-Leitlinie – Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus. Z Gastroenterol 2019; 57: 336-418
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 Kondrup J, Allison SP, Elia M. et al. ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003; 22: 415-421
    CrossrefPubMedSearch in Google Scholar
  • 16 Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) in Kooperation mit der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). S3-Leitlinie „Präoperative Anämie“: Diagnostik und Therapie der Präoperativen Anämie. AWMF-Registernummer 0001–0024, Version 1.0 vom 11.04.2018. Im Internet (Stand: 07.02.2021): https://www.awmf.org/uploads/tx_szleitlinien/001-024l_S3_Praeoperative-Anaemie_2018-04-verlaengert.pdf
  • 17 Smith MD, McCall J, Plank L. et al. Preoperative carbohydrate treatment for enhancing recovery after elective surgery. Cochrane Database Syst Rev 2014; (08) CD009161
    CrossrefPubMedSearch in Google Scholar
  • 18 Tagkalos E, Goense L, Hoppe-Lotichius M. et al. Robot-assisted minimally invasive esophagectomy (RAMIE) compared to conventional minimally invasive esophagectomy (MIE) for esophageal cancer: A propensity-matched analysis. Dis Esophagus 2020; 33: doz060
    CrossrefPubMedSearch in Google Scholar
  • 19 Tsunoda S, Obama K, Hisamori S. et al. Lower Incidence of Postoperative Pulmonary Complications Following Robot-Assisted Minimally Invasive Esophagectomy for Esophageal Cancer: Propensity Score-Matched Comparison to Conventional Minimally Invasive Esophagectomy. Ann Surg Oncol 2021; 28: 639-647
    CrossrefPubMedSearch in Google Scholar
  • 20 Kuppusamy M, Low D. International Esodata Study Group (IESG). Evaluation of International Contemporary Operative Outcomes and Management Trends Associated With Esophagectomy: A 4-Year Study of > 6000 Patients Using ECCG Definitions and the Online Esodata Database. Ann Surg 2020; Epub ahead of print
    CrossrefPubMedSearch in Google Scholar
  • 21 Mariette C, Markar SR, Dabakuyo-Yonli TS. et al. Hybrid Minimally Invasive Esophagectomy for Esophageal Cancer. N Engl J Med 2019; 380: 152-162
    CrossrefPubMedSearch in Google Scholar
  • 22 Lambertz R, Drinhaus H, Schedler D. et al. Perioperatives Management der transthorakalen Ösophagektomie: Grundlagen der interdisziplinären Patientenversorgung und neue Konzepte zur beschleunigten postoperativen Erholung. Anaesthesist 2016; 65: 458-466
    CrossrefPubMedSearch in Google Scholar
  • 23 Fares KM, Mohamed SA, Hamza HM. et al. Effect of Thoracic Epidural Analgesia on Pro-inflammatory Cytokines in Patients Subjected to Protective Lung Ventilation During Ivor Lewis Esophagectomy. Pain Physician 2014; 17: 305-315
    PubMedSearch in Google Scholar
  • 24 Yokoyama M, Itano Y, Katayama H. et al. The Effects of Continuous Epidural Anesthesia and Analgesia on Stress Response and Immune Function in Patients Undergoing Radical Esophagectomy. Anesth Analg 2005; 101: 1521-1527
    CrossrefPubMedSearch in Google Scholar
  • 25 Cense HA, Lagarde SM, De Jong K. et al. Association of no epidural analgesia with postoperative morbidity and mortality after transthoracic esophageal cancer resection. J Am Coll Surg 2006; 202: 395-400
    CrossrefPubMedSearch in Google Scholar
  • 26 Vogt A, Eberle B. Pathophysiologie des Kapnoperitoneums. Anaesthesist 2009; 58: 520-526
    CrossrefPubMedSearch in Google Scholar
  • 27 Michelet P, DʼJourno XB, Roch A. et al. Protective ventilation influences systemic inflammation after esophagectomy: A randomized controlled study. Anesthesiology 2006; 105: 911-919
    CrossrefPubMedSearch in Google Scholar
  • 28 Verhage RJJ, Boone J, Rijkers GT. et al. Reduced local immune response with continuous positive airway pressure during one-lung ventilation for oesophagectomy. Br J Anaesth 2014; 112: 920-928
    CrossrefPubMedSearch in Google Scholar
  • 29 Becker BF, Chappell D, Bruegger D. et al. Therapeutic strategies targeting the endothelial glycocalyx: acute deficits, but great potential. Cardiovasc Res 2010; 87: 300-310
    CrossrefPubMedSearch in Google Scholar
  • 30 Bartels K, Fiegel M, Stevens Q. et al. Approaches to perioperative care for esophagectomy. J Cardiothorac Vasc Anesth 2015; 29: 472-480
    CrossrefPubMedSearch in Google Scholar
  • 31 Lanuti M, de Delva PE, Maher A. et al. Feasibility and Outcomes of an Early Extubation Policy After Esophagectomy. Ann Thorac Surg 2006; 82: 2037-2041
    CrossrefPubMedSearch in Google Scholar
  • 32 Benedix F, Willems T, Kropf S. et al. Risk factors for delayed gastric emptying after esophagectomy. Langenbecks Arch Surg 2017; 402: 547-554
    CrossrefPubMedSearch in Google Scholar
  • 33 Akkerman RDL, Haverkamp L, van Hillegersberg R. et al. Surgical Techniques to Prevent Delayed Gastric Emptying After Esophagectomy With Gastric Interposition: A Systematic Review. Ann Thorac Surg 2014; 98: 1512-1519
    CrossrefPubMedSearch in Google Scholar
  • 34 Sun H-B, Li Y, Liu X-B. et al. Early Oral Feeding Following McKeown Minimally Invasive Esophagectomy. Ann Surg 2018; 267: 435-442
    CrossrefPubMedSearch in Google Scholar
  • 35 Berkelmans GHK, Fransen LFC, Dolmans-Zwartjes ACP. et al. Direct Oral Feeding Following Minimally Invasive Esophagectomy (NUTRIENT II trial): An International, Multicenter, Open-label Randomized Controlled Trial. Ann Surg 2020; 271: 41-47
    CrossrefPubMedSearch in Google Scholar
  • 36 Fransen LFC, Berkelmans GHK, Asti E. et al. The Effect of Postoperative Complications After Minimally Invasive Esophagectomy on Long-term Survival: An International Multicenter Cohort Study. Ann Surg 2020;
    CrossrefPubMedSearch in Google Scholar
  • 37 Weijs TJ, van Eden HWJ, Ruurda JP. et al. Routine jejunostomy tube feeding following esophagectomy. J Thorac Dis 2017; 9 (Suppl. 08) S851-S860
    CrossrefPubMedSearch in Google Scholar
  • 38 Zheng R, Rios-Diaz AJ, Liem S. et al. Is the placement of jejunostomy tubes in patients with esophageal cancer undergoing esophagectomy associated with increased inpatient healthcare utilization? An analysis of the National Readmissions Database. Am J Surg 2021; 221: 141-148
    CrossrefPubMedSearch in Google Scholar
  • 39 Konradsson M, van Berge Henegouwen MI, Bruns C. et al. Diagnostic criteria and symptom grading for delayed gastric conduit emptying after esophagectomy for cancer: international expert consensus based on a modified Delphi process. Dis Esophagus 2020; 33: doz074
    CrossrefPubMedSearch in Google Scholar
  • 40 Low DE, Kunz S, Schembre D. et al. Esophagectomy–itʼs not just about mortality anymore: standardized perioperative clinical pathways improve outcomes in patients with esophageal cancer. J Gastrointest Surg 2007; 11: 1395-1402
    CrossrefPubMedSearch in Google Scholar
  • 41 Findlay JM, Gillies RS, Millo J. et al. Enhanced recovery for esophagectomy: A systematic review and evidence-based guidelines. Ann Surg 2014; 259: 413-431
    CrossrefPubMedSearch in Google Scholar
  • 42 Shewale JB, Correa AM, Baker CM. et al. Impact of a fast-track esophagectomy protocol on esophageal cancer patient outcomes and hospital charges. Ann Surg 2015; 261: 1114-1123
    CrossrefPubMedSearch in Google Scholar
  • 43 Markar SR, Schmidt H, Kunz S. et al. Evolution of Standardized Clinical Pathways: Refining Multidisciplinary Care and Process to Improve Outcomes of the Surgical Treatment of Esophageal Cancer. J Gastrointest Surg 2014; 18: 1238-1246
    CrossrefPubMedSearch in Google Scholar
  • 44 Baltin CT, Bludau M, Kron F. et al. Profit-Center-Analyse der Ösophagektomie: Ökonomische Analyse der transthorakalen Ösophagektomie in Abhängigkeit von postoperativen Komplikationen. Chirurg 2018; 89: 229-236
    CrossrefPubMedSearch in Google Scholar
  • 45 van Rossum PSN, Haverkamp L, Verkooijen HM. et al. Calcification of Arteries Supplying the Gastric Tube: A New Risk Factor for Anastomotic Leakage after Esophageal Surgery. Radiology 2015; 274: 124-132
    CrossrefPubMedSearch in Google Scholar
  • 46 Goense L, van Rossum PSN, Weijs TJ. et al. Aortic Calcification Increases the Risk of Anastomotic Leakage after Ivor-Lewis Esophagectomy. Ann Thorac Surg 2016; 102: 247-252
    CrossrefPubMedSearch in Google Scholar
  • 47 Brinkmann S, Chang DH, Kuhr K. et al. Stenosis of the celiac trunk is associated with anastomotic leak after Ivor-Lewis esophagectomy. Dis Esophagus 2019; 32: doy107
    CrossrefPubMedSearch in Google Scholar
  • 48 Schröder W, Höscher AH, Bludau M. et al. Ivor-Lewis esophagectomy with and without laparoscopic conditioning of the gastric conduit. World J Surg 2010; 34: 738-743
    CrossrefPubMedSearch in Google Scholar
  • 49 Bartella I, Brinkmann S, Fuchs H. et al. Two-stage hybrid Ivor-Lewis esophagectomy as surgical strategy to reduce postoperative morbidity for high-risk patients. Surg Endosc 2021; 35: 1182-1189
    CrossrefPubMedSearch in Google Scholar
  • 50 Babic B, Tagkalos E, Gockel I. et al. C-reactive Protein Levels After Esophagectomy Are Associated With Increased Surgical Trauma and Complications. Ann Thorac Surg 2020; 109: 1574-1583
    CrossrefPubMedSearch in Google Scholar
  • 51 Low DE, Alderson D, Cecconello I. et al. International Consensus on Standardization of Data Collection for Complications Associated With Esophagectomy. Ann Surg 2015; 262: 286-294
    CrossrefPubMedSearch in Google Scholar
  • 52 Müller PC, Kapp JR, Vetter D. et al. Fit-for-Discharge Criteria after Esophagectomy: An International Expert Delphi Consensus. Dis Esophagus 2020;
    CrossrefPubMedSearch in Google Scholar
  • 53 Cerfolio RJ, Bryant AS, Bass CS. et al. Fast tracking after ivor lewis esophagogastrectomy. Chest 2004; 126: 1187-1194
    CrossrefPubMedSearch in Google Scholar
  • 54 Jiang K, Cheng L, Wang JJ. et al. Fast track clinical pathway implications in esophagogastrectomy. World J Gastroenterol 2009; 15: 496-501
    CrossrefPubMedSearch in Google Scholar
  • 55 Li C, Ferri LE, Mulder DS. et al. An enhanced recovery pathway decreases duration of stay after esophagectomy. Surgery 2012; 152: 606-614 discussion 614–616
    CrossrefPubMedSearch in Google Scholar
  • 56 Cao S, Zhao G, Cui J. et al. Fast-track rehabilitation program and conventional care after esophagectomy: A retrospective controlled cohort study. Support Care Cancer 2013; 21: 707-714
    CrossrefPubMedSearch in Google Scholar
  • 57 Tang J, Humes DJ, Gemmil E. et al. Reduction in length of stay for patients undergoing oesophageal and gastric resections with implementation of enhanced recovery packages. Ann R Coll Surg Engl 2013; 95: 323-328
    CrossrefPubMedSearch in Google Scholar
  • 58 Preston SR, Markar SR, Baker CR. et al. Impact of a multidisciplinary standardized clinical pathway on perioperative outcomes in patients with oesophageal cancer. Br J Surg 2013; 100: 105-112
    CrossrefPubMedSearch in Google Scholar
  • 59 Lee L, Li C, Robert N. et al. Economic impact of an enhanced recovery pathway for oesophagectomy. Br J Surg 2013; 100: 1326-1334
    CrossrefPubMedSearch in Google Scholar
  • 60 Blom RLGM, Van Heijl M, Bemelman WA. et al. Initial experiences of an enhanced recovery protocol in esophageal surgery. World J Surg 2013; 37: 2372-2378
    CrossrefPubMedSearch in Google Scholar
  • 61 Ford SJ, Adams D, Dudnikov S. et al. The implementation and effectiveness of an enhanced recovery programme after oesophago-gastrectomy: A prospective cohort study. Int J Surg 2014; 12: 320-324
    CrossrefPubMedSearch in Google Scholar
  • 62 Zhao G, Cao S, Cui J. Fast-track surgery improves postoperative clinical recovery and reduces postoperative insulin resistance after esophagectomy for esophageal cancer. Support Care Cancer 2014; 22: 351-358
    CrossrefPubMedSearch in Google Scholar
  • 63 De Pasqual CA, Torroni L, Gervasi MC. et al. Feasibility and safety of an enhanced recovery protocol (ERP) for upper GI surgery in elderly patients (≥ 75 years) in a high-volume surgical center. Updates Surg 2020; 72: 751-760
    CrossrefPubMedSearch in Google Scholar