Japanese

Title	食道癌における低侵襲手術の導入とERAS (Enhanced recovery after surgery) による周術期管理の有用性
Subtitle	原著 (臨床研究)
Authors	小倉正治, 長谷川博俊, 松井淳一
Authors (kana)
Organization	東京歯科大学市川総合病院外科
Journal	外科と代謝・栄養
Volume	54
Number	3
Page	147-153
Year/Month	2020 / 8
Article	原著
Publisher	日本外科代謝栄養学会
Abstract	高侵襲手術である食道癌手術での周術期合併症を軽減し, 安全かつ迅速に術後回復を促進するため, 低侵襲手術である胸腔鏡下食道切除術の導入とEnhanced recovery after surgery (ERAS)による周術期管理を開始した. 2016年12月より胸腔鏡下食道切除術を開始し, ERASプロトコルの変更を行った. 2016年12月〜2019年8月にかけて, 食道癌に対し上縦隔リンパ節郭清を施行した胸腔鏡下食道切除術23例(VATS群)を対象とし, それ以前に施行した開胸手術55例(No VATS群)との周術期転帰の比較を行った. VATS群において, 縫合不全は有意に減少し, また, 術後気管内挿管の期間, 集中治療室滞在日数, 経口摂取開始までの日数, 術後在院日数は, それぞれ有意に短縮された. 食道癌手術における胸腔鏡下食道切除とERASプロトコルの変更により, 患者の周術期アウトカムの改善が見込まれると推察された. 治療成績の安定化のため, 食道癌手術におけるクリニカルパスを導入したため, さらにその成果を期待したい.
Practice	臨床医学：外科系
Keywords	食道癌, 胸腔鏡下手術, ERAS, esophageal carcinoma, VATS

English

Title	Usefulness of minimally invasive surgery and ERAS (enhanced recovery after surgery) in esophagectomy for esophageal cancer
Subtitle
Authors	Masaharu Ogura, Hirotoshi Hasegawa, Junichi Matsui
Authors (kana)
Organization	Department of Surgery, Tokyo Dental College Ichikawa General Hospital
Journal	The Japanese Journal of Surgical Metabolism and Nutrition
Volume	54
Number	3
Page	147-153
Year/Month	2020 / 8
Article	Original article
Publisher	Japanese Society for Surgical Metabolism and Nutrition
Abstract	Minimally invasive radical esophagectomy and a new protocol for enhanced recovery after surgery (ERAS) were introduced in order to reduce perioperative complications and promote safe and quick postoperative recovery. To implement the ERAS protocol, many medical staff members must participate in perioperative management. Thoracoscopic esophagectomy was started in December 2016 at our hospital. In this study, we examined the usefulness of thoracoscopic esophagectomy and the ERAS protocol in esophageal cancer surgery. We compared perioperative outcomes for thoracoscopic esophagectomy between 23 patients (VATS group) who underwent superior mediastinal lymph node dissection between December 2016 and August 2019 and 55 patients who underwent open esophagectomy (No VATS group). In the VATS group, anastomotic leakage was significantly reduced, and the length of postoperative tracheal intubation, days of staying in the intensive care unit, days to start intake after surgery, and hospital period after surgery were significantly shortened. The introduction of thoracoscopic esophagectomy and the new ERAS protocol are expected to improve the perioperative outcome of patients with esophageal cancer. We have introduced a clinical pathway for esophageal cancer surgery in order to improve the outcome of patients with esophageal cancer.
Practice	Clinical surgery
Keywords	esophageal carcinoma, VATS, ERAS

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