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Erschienen in: European Surgery 2/2015

01.04.2015 | Main Topic

Fast-track Ivor Lewis esophageal resection

verfasst von: Univ. Doz. Dr. J. Zacherl, R. Asari, E. Fleischmann, B. Karbon, S. Rasoul-Rockenschaub, G. Prager, F.M. Riegler, S.F. Schoppmann

Erschienen in: European Surgery | Ausgabe 2/2015

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Summary

Background

Esophagectomy for primary esophageal cancer is a high-risk procedure. The main reason for hospital mortality is respiratory morbidity. A fast recovery protocol has been introduced to enhance recovery and to reduce postoperative morbidity.

Methods

Patients who underwent minimally invasive, hybrid, or open abdominothoracic esophagectomy and intrathoracic esophagogastrostomy between June 2006 and October 2009 were perioperatively managed according to a multistep recovery protocol. Patients with colon interposition, jejunum interposition, Roux-en-Y reconstruction, or chest or supradiaphragmatic anastomosis were excluded from the respective fast-track protocol. Association between several circumstances and protocol dropout was evaluated.

Results

Overall, 90 consecutive patients (median age, 64.3 years; 17 female) were intended to be treated according to the fast recovery protocol. Major morbidity was 21.1 %, respiratory morbidity was 11.1 %, and hospital mortality was 3.3 %. Protocol failure occurred in 36.7 %, and readmission rate was 2.2 %. Factors associated with failure were pre-existing combined comorbidities (i.e., ASA 3), blood transfusions, thoracoscopic creation of the esophagogastrostomy, and postoperative major complications.

Conclusions

The fast-track goal was reached in almost two-thirds of patients undergoing Ivor Lewis resection. Multimodal measures reduce pulmonary complication and pneumonia rate without increasing surgical morbidity.
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Metadaten
Titel
Fast-track Ivor Lewis esophageal resection
verfasst von
Univ. Doz. Dr. J. Zacherl
R. Asari
E. Fleischmann
B. Karbon
S. Rasoul-Rockenschaub
G. Prager
F.M. Riegler
S.F. Schoppmann
Publikationsdatum
01.04.2015
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 2/2015
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-015-0304-1

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