Abstract
BackgroundPerioperative rehabilitation management is essential to enhanced recovery after surgery (ERAS). Limited reports, however, have focused on quantitative, detailed early activity plans for patients receiving minimally invasive esophagectomy (MIE). The purpose of this research was to estimate the effectiveness of the Tailored, Early Comprehensive Rehabilitation Program (t-ECRP) based on ERAS in the recovery of bowel and physical functions for patients undergoing MIE.MethodsIn this single-blind, 2-arm, parallel-group, randomized pilot clinical trial, patients admitted to the Affiliated Cancer Hospital of Zhengzhou University from June 2019 to February 2020 were selected and randomly assigned to an intervention group (IG) or a control group (CG). The participants in the IG received medical care based on the t-ECRP strategy during perioperative period, and participants in the CG received routine care. The recovery of bowel and physical functions, readiness for hospital discharge (RHD), and postoperative hospital stay were evaluated on the day of discharge.ResultsTwo hundred and fifteen cases with esophageal cancer (EC) were enrolled and randomized to the IG (n = 107) or CG (n = 108). The mean age was 62.58 years (SD 9.07) and 71.16% were male. For EC, 53.49% were mid-location cancers and 79.07% were classified as pathological stage II and III cancers. There were no significant differences between the two groups in terms of demographic and clinical characteristics and baseline physical functions. Participants in the IG group presented significantly shorter lengths of time to first flatus (P < 0.001), first postoperative bowel movement (P = 0.024), and for up and go test (P < 0.001), and lower scores of frailty (P < 0.001). The analysis also showed that participants in the IG had higher scores of RHD and shorter lengths of postoperative stay than in the CG (P < 0.05).ConclusionsThe t-ECRP appears to improve bowel and physical function recovery, ameliorate RHD, and shorten postoperative hospital stay for patients undergoing MIE. Clinicians should consider prescribing quantitative, detailed, and individualized early activity plans for these patients.Trial registrationClinicalTrials.gov (Identifier: NCT01998230)
Highlights
Esophageal cancer (EC), a malignant tumor that occurs in the epithelial tissue of the esophagus, is the eighth most common cancer and the sixth most common cause of death overall on the global burden of cancer worldwide [1]
With the help of randomization codes produced by means of the PROC PLAN of the SAS system, patients with esophageal cancer (EC) undergoing minimally invasive esophagectomy (MIE) were randomly divided into intervention group (IG) and control group (CG) with a 1:1 assignment ratio
All patients underwent a preoperative assessment on the day of admission, and data about sociodemographic details, medical history, and comorbidities were collected
Summary
Esophageal cancer (EC), a malignant tumor that occurs in the epithelial tissue of the esophagus, is the eighth most common cancer and the sixth most common cause of death overall on the global burden of cancer worldwide [1]. ERAS was described first in 1997 by Henrik Kehlet, which has been widely applied to reduce the surgical stress response, postoperative medical complications, and hospital stay, and improve recovery after surgery [4,5,6,7]. The purpose of this research was to estimate the effectiveness of the Tailored, Early Comprehensive Rehabilitation Program (t-ECRP) based on ERAS in the recovery of bowel and physical functions for patients undergoing MIE. The recovery of bowel and physical functions, readiness for hospital discharge (RHD), and postoperative hospital stay were evaluated on the day of discharge. Conclusions The t-ECRP appears to improve bowel and physical function recovery, ameliorate RHD, and shorten postoperative hospital stay for patients undergoing MIE.
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