Fast-Track-Rehabilitation nach Ösophagektomie

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

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