oncotomskСибирский онкологический журналSiberian journal of oncology1814-48612312-3168Tomsk National Research Medical Сепtеr of the Russian Academy of Sciencesoncotomsk-81Research ArticleОПЫТ РАБОТЫ ОНКОЛОГИЧЕСКИХ УЧРЕЖДЕНИЙONCOLOGY PRACTICEУск оренная госпитальная реабилитация больных после расширенно-комбинированных операций по поводу рака грудного отдела пищевода и кардииACCELERATED HOSPITAL REHABILITATION OF PATIENTS AFTER EXTENDED-COMBINED SURGERIES FOR CANCER OF THORACIC ESOPHAGUS AND CARDIAВолковаЕ. Э.VolkovaE. E.evolkova_mnioi@mail.ruВашакмадзеЛ. А.VashakmadzeL. A.ХомяковВ. М.KhomyakovV. M.vladimirkhom@mail.ruМамонтовА. С.MamontovA. S.ФГБУ «МНИОИ им. П.А. Герцена» Минздравсоцразвития РоссииРоссияP.A. Gertsen Moscow Research Institute of Oncology of the Ministry of Health and Social DevelopmentRussian Federation20131502201601Сибирский онкологический журнал5258Copyright © Волкова Е.Э., Вашакмадзе Л.А., Хомяков В.М., Мамонтов А.С., 20162016Волкова Е.Э., Вашакмадзе Л.А., Хомяков В.М., Мамонтов А.С.Volkova E.E., Vashakmadze L.A., Khomyakov V.M., Mamontov A.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.siboncoj.ru/jour/article/view/81

Проведена оценка эффективности протокола предоперационной подготовки и ускоренной реабилитации пациентов при хирургическом лечении рака грудного отдела пищевода, разработанного в МНИОИ им. П.А. Герцена. Данный протокол создан на основании анализа непосредственных результатов оперативного лечения 190 больных раком пищевода. Разработанный алгоритм применен у 30 больных раком пищевода и кардии. В основной группе послеоперационные осложнения возникли у 12 (40 %) пациентов, в том числе хирургические – у 4 (хилоторакс – 2, несостоятельность пищеводно-кишечного анастомоза – 1, тонкокишечная непро-ходимость – 1). Нехирургические осложнения при отсутствии хирургических отмечены у 7 пациентов (пневмония – 6, нарушения ритма сердца по типу фибрилляции предсердий – 1). Летальных исходов не было. В контрольной ретроспективной группе (n=50) больным операции выполнялись в аналогичном объеме после стандартной предоперационной подготовки. В контрольной группе послеоперационные осложнения отмечены в 28 (48 %) случаях, умерло 4 (8 %) больных. Средний послеоперационный койко-день в основной группе составил 11 (10–29), в контрольной – 18. Таким образом, разработанный нами протокол предоперационного обследования и подготовки пациентов позволяет значительно уменьшить частоту послеоперационных осложнений и летальность, что приводит к сокращению сроков пребывания в стационаре.

The efficacy of the protocol of preoperative preparation and accelerated rehabilitation of patients in surgical treatment of thoracic esophageal cancer was aevaluated. The protocol was based on the analysis of short-term results of surgical treatment of 190 patients with esophageal cancer. The algorithm devised at the Moscow Research Institute of Oncology was applied to 30 patients with cancer of the esophagus and cardia. Postoperative complications occurred in 12 (40 %) patients of the study group including surgical complications in 4 patients (chylothorax – 2, failure of the esophageal-intestinal anastomosis – 1, small bowel obstruction – 1). Nonsurgical complications in the absence of surgical ones were noted in 7 patients (pneumonia – 6, heart rhythm disturbances – 1). No lethal outcomes were registered. Patients in the control retrospective group (n=50) underwent surgeries in the same extent after the standard preoperative preparation. Postoperative complications in the control group occurred in 28 (48 %) cases, 4 (8 %) patients died. The median postoperative hospital stay was 11 days (range: 10–29 days) in the study group and 18 days in the control group. Accordingly, the above protocol of preoperative examination and preparation of patients allows the frequency of  postoperative complications and lethality to be significantly decreased, thus reducing the hospital stay.

рак пищеводахирургическое лечениепредоперационная подготовкаesophageal cancersurgical treatmentpreoperative preparationReferencesAssociation of Surgeons of Great Britain and Ireland. Guidelines for implementation of enhanced recovery protocols. Issues in professional practice, 2009.Association of Surgeons of Great Britain and Ireland. Guidelines for implementation of enhanced recovery protocols. Issues in professional practice, 2009.Cerfolio R.J., Bryant A.S., Bass C.S. et al. Fast tracking after Ivor Lewis esophagogastrectomy // Chest. 2004. Vol. 126. P. 1187–1194.Cerfolio R.J., Bryant A.S., Bass C.S. et al. Fast tracking after Ivor Lewis esophagogastrectomy // Chest. 2004. Vol. 126. P. 1187–1194.Griffin S.M., Shaw I.H., Dresner S.M. Early complications after Ivor Lewis subtotal esophagectomy with two-field lymphadenectomy: risk factors and management // J. Am. Coll. Surg. 2002. Vol. 194. P. 285–297.Griffin S.M., Shaw I.H., Dresner S.M. Early complications after Ivor Lewis subtotal esophagectomy with two-field lymphadenectomy: risk factors and management // J. Am. Coll. Surg. 2002. Vol. 194. P. 285–297.Hofstetter W., Swisher S.G., Correa A.M. et al. Treatment outcomes of resected esophageal cancer // Ann. Surg. 2002. Vol. 236. P. 376–384.Hofstetter W., Swisher S.G., Correa A.M. et al. Treatment outcomes of resected esophageal cancer // Ann. Surg. 2002. Vol. 236. P. 376–384.Karl R.C., Schreiber R., Boulware D. et al. Factors affecting morbidity, mortality, and survival in patients undergoing Ivor Lewis esophagogastrectomy // Ann. Surg. 2000. Vol. 231. P. 635–643.Karl R.C., Schreiber R., Boulware D. et al. Factors affecting morbidity, mortality, and survival in patients undergoing Ivor Lewis esophagogastrectomy // Ann. Surg. 2000. Vol. 231. P. 635–643.Kehlet H., Willmore D.W. Multi-modal strategies to improve surgical outcome // Amer. J. Surg. 2002. Vol. 183. P. 600.Kehlet H., Willmore D.W. Multi-modal strategies to improve surgical outcome // Amer. J. Surg. 2002. Vol. 183. P. 600.Kehlet H.,Wilmore D.W. Evidence-based surgical care and the evolution of fast-track surgery // Ann. Surg. 2008. Vol. 248 (2). P. 189–198.Kehlet H.,Wilmore D.W. Evidence-based surgical care and the evolution of fast-track surgery // Ann. Surg. 2008. Vol. 248 (2). P. 189–198.Kehlet H.,Wilmore D.W. Fast-track surgery // Br. J. Surg. 2005. Vol. 92. P. 3–4.Kehlet H.,Wilmore D.W. Fast-track surgery // Br. J. Surg. 2005. Vol. 92. P. 3–4.Ke Jiang, Lin Cheng, Jian-Jun Wang et al. Fast track clinical pathway implications in esophagogastrectomy // World J. Gastroenterol. 2009. Vol. 15 (4). P. 496–501.Ke Jiang, Lin Cheng, Jian-Jun Wang et al. Fast track clinical pathway implications in esophagogastrectomy // World J. Gastroenterol. 2009. Vol. 15 (4). P. 496–501.Low D., Kunz S., Schembre D. et al. Esophagectomy – it’s not just about mortality anymore: standardized perioperative clinical pathways improve outcomes in patients with esophageal cancer // J. Gastrointest. Surg. 2007. Vol. 11 (11). P. 1395–1402.Low D., Kunz S., Schembre D. et al. Esophagectomy – it’s not just about mortality anymore: standardized perioperative clinical pathways improve outcomes in patients with esophageal cancer // J. Gastrointest. Surg. 2007. Vol. 11 (11). P. 1395–1402.Luketich J.D., Alvelo-Rivera M., Buenaventura P.O. et al. Minimallyinvasive esophagectomy: outcomes in 222 patients // Ann. Surg. 2003. Vol. 238. P. 486–494.Luketich J.D., Alvelo-Rivera M., Buenaventura P.O. et al. Minimallyinvasive esophagectomy: outcomes in 222 patients // Ann. Surg. 2003. Vol. 238. P. 486–494.Meakins, J.L. Innovations in surgery: the rules of evidence // Am. J. Surg. 2002. Vol. 183. P. 399–405.Meakins, J.L. Innovations in surgery: the rules of evidence // Am. J. Surg. 2002. Vol. 183. P. 399–405.Munitiz V., Martinez-de-Haro L.F., Ortiz A. et al. Effectiveness of a written clinical pathway for enhanced recovery after transthoracic (Ivor Lewis) oesophagectomy // Br. J. Surg. 2010. Vol. 97. P. 714–718.Munitiz V., Martinez-de-Haro L.F., Ortiz A. et al. Effectiveness of a written clinical pathway for enhanced recovery after transthoracic (Ivor Lewis) oesophagectomy // Br. J. Surg. 2010. Vol. 97. P. 714–718.Nguyen N.T., Hinojosa M.W., Smith B.R. et al. Minimally invasive esophagectomy: lessons learned from 104 operations // Ann. Surg. 2008. Vol. 248. P. 1081–1091.Nguyen N.T., Hinojosa M.W., Smith B.R. et al. Minimally invasive esophagectomy: lessons learned from 104 operations // Ann. Surg. 2008. Vol. 248. P. 1081–1091.Roig-Garcıa J., Girones-Vila J., Garsot-Savall E. et al. Transthoracic and transhiatal esophagectomy using minimally invasive techniques. Experience in 50 patients // Cir. Esp. 2008. Vol. 83. P. 180–185.Roig-Garcıa J., Girones-Vila J., Garsot-Savall E. et al. Transthoracic and transhiatal esophagectomy using minimally invasive techniques. Experience in 50 patients // Cir. Esp. 2008. Vol. 83. P. 180–185.Smithers B.M., Gotley D.C., Martin I., Thomas J.M. Comparison of the outcomes between open and minimally invasive esophagectomy // Ann. Surg. 2007. Vol. 245. P. 232–240.Smithers B.M., Gotley D.C., Martin I., Thomas J.M. Comparison of the outcomes between open and minimally invasive esophagectomy // Ann. Surg. 2007. Vol. 245. P. 232–240.

The authors declare that there are no conflicts of interest present.