切换至 "中华医学电子期刊资源库"

中华结直肠疾病电子杂志 ›› 2018, Vol. 07 ›› Issue (05) : 402 -406. doi: 10.3877/cma.j.issn.2095-3224.2018.05.001

所属专题: 文献

专家论坛

加速康复外科在结直肠癌中的应用
郑朝旭1,(), 卢召1   
  1. 1. 100021 北京,国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院结直肠外科
  • 收稿日期:2017-11-19 出版日期:2018-10-25
  • 通信作者: 郑朝旭
  • 基金资助:
    国家重点研发计划(No.2017YFC0908203); 中国医学科学院医学与健康科技创新工程(NO.2017-12M-2-003)

Enhanced recovery after surgery in colorectal cancer

Zhaoxu Zheng1,(), Zhao Lu1   

  1. 1. Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
  • Received:2017-11-19 Published:2018-10-25
  • Corresponding author: Zhaoxu Zheng
  • About author:
    Corresponding author: Zheng Zhaoxu, Email:
引用本文:

郑朝旭, 卢召. 加速康复外科在结直肠癌中的应用[J]. 中华结直肠疾病电子杂志, 2018, 07(05): 402-406.

Zhaoxu Zheng, Zhao Lu. Enhanced recovery after surgery in colorectal cancer[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2018, 07(05): 402-406.

加速康复外科(ERAS)是一种优化的围手术期的先进理念,包含一系列能够促进患者术后康复,减少手术应激及并发症,缩短住院时间,降低住院费用的措施。ERAS理念在外科领域得到了广泛应用和推广,但目前国内ERAS的普及率仍很低,这可能与外科医师和患者对这一概念的认识不足有关。本文对ERAS在结直肠癌中的应用及最新进展做一综述,并深入分析ERAS对结直肠癌患者长期生存率的影响,为ERAS在结直肠肿瘤外科中的推广应用提供参考,从而使更多结直肠癌患者从中受益。

As a optimized advanced concept of perioerative period, enhanced recovery after surgery (ERAS) employs a multimodal perioperative care pathway with the aim of accelerating recovery, attenuating the stress response to surgery, reducing complications, shortening the postoperative hospital stay and decreasing hospital expenditure. The ERAS principle has been accepted and expanded extensively in the surgery field, however, the popularization of ERAS in China is still very low, which may be relative to insufficient understanding of ERAS among surgeons and patients. We reviewed the application and latest advancement of ERAS in colorectal cancer, and make a deep analysis of influence on the long-trem survival so as to provide a reference for the widespread application of ERAS in colorectal cancer and make more patients benefit from it.

[1]
Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015 [J]. CA: A Cancer Journal for Clinicians, 2016, 66(2):115-132.
[2]
Wilmore DW, Kehlet H. Management of patients in fast track surgery [J]. BMJ, 2001, 322(7284):473-476.
[3]
Basse L, Hjort JD, Billesbolle P, et al. A clinical pathway to accelerate recovery after colonic resection [J]. Ann Surg, 2000, 232(1):51-57.
[4]
Wang G, Jiang ZW, Xu J, et al. Fast-track rehabilitation program vs conventional care after colorectal resection: a randomized clinical trial [J]. World J Gastroenterol, 2011, 17(5):671-676.
[5]
Wang H, Zhu D, Liang L, et al. Short-term quality of life in patients undergoing colonic surgery using enhanced recovery after surgery program versus conventional perioperative management [J]. Qual Life Res, 2015, 24(11):2663-2670.
[6]
Carmichael JC, Keller DS, Baldini G, et al. Clinical practice guideline for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons (ASCRS) and Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) [J]. Surg Endosc, 2017, 31(9):3412-3436.
[7]
中华医学会肠外肠内营养学分会加速康复外科协作组. 结直肠手术应用加速康复外科中国专家共识(2015版) [J]. 中华消化外科杂志, 2015, 14(8):606-608.
[8]
Papamichael D, Audisio R, Horiot JC, et al. Treatment of the elderly colorectal cancer patient: SIOG expert recommendations [J]. Ann Oncol, 2009, 20(1):5-16.
[9]
Gonzalez-Ayora S, Pastor C, Guadalajara H, et al. Enhanced recovery care after colorectal surgery in elderly patients. Compliance and outcomes of a multicenter study from the Spanish working group on ERAS [J]. Int J Colorectal Dis, 2016, 31(9):1625-1631.
[10]
Bagnall NM, Malietzis G, Kennedy RH, et al. A systematic review of enhanced recovery care after colorectal surgery in elderly patients [J]. Colorectal Dis, 2014, 16(12):947-956.
[11]
Baek SJ, Kim SH, Kim SY, et al. The safety of a ″fast-track″ program after laparoscopic colorectal surgery is comparable in older patients as in younger patients [J]. Surg Endosc, 2013, 27(4):1225-1232.
[12]
Feroci F, Lenzi E, Baraghini M, et al. Fast-track surgery in real life: how patient factors influence outcomes and compliance with an enhanced recovery clinical pathway after colorectal surgery [J]. Surg Laparosc Endosc Percutan Tech, 2013, 23(3):259-265.
[13]
Khan MA, Pandey S. Clinical outcomes of the very elderly undergoing enhanced recovery programmes in elective colorectal surgery [J]. Ann R Coll Surg Engl, 2016, 98(1):29-33.
[14]
Braga M, Beretta L, Pecorelli N, et al. Enhanced recovery pathway in elderly patients undergoing colorectal surgery: is there an effect of increasing ages? Results from the perioperative Italian Society Registry [J]. Updates Surg, 2018, 70(1):7-13.
[15]
Ansaloni L, Andersson RE, Bazzoli F, et al. Guidelenines in the management of obstructing cancer of the left colon: consensus conference of the world society of emergency surgery (WSES) and peritoneum and surgery (PnS) society [J]. World J Emerg Surg, 2010, 5:29.
[16]
Lohsiriwat V. Enhanced recovery after surgery vs conventional care in emergency colorectal surgery [J]. World J Gastroenterol, 2014, 20(38):13950-13955.
[17]
Cirocchi R, Trastulli S, Abraha I, et al. Non-resection versus resection for an asymptomatic primary tumour in patients with unresectable stage IV colorectal cancer [J]. Cochrane Database Syst Rev, 2012, (8):D8997.
[18]
Konyalian VR, Rosing DK, Haukoos JS, et al. The role of primary tumour resection in patients with stage IV colorectal cancer [J]. Colorectal Dis, 2007, 9(5):430-437.
[19]
Pedziwiatr M, Pisarska M, Kisielewski M, et al. Enhanced Recovery After Surgery (ERAS(R)) protocol in patients undergoing laparoscopic resection for stage IV colorectal cancer [J]. World J Surg Oncol, 2015, 13:330.
[20]
Hubner M, Muller S, Schafer M, et al. Impact of the nutritional risk score in fast-track colon surgery [J]. Dig Surg, 2010, 27(5):436-439.
[21]
Lohsiriwat V. The influence of preoperative nutritional status on the outcomes of an enhanced recovery after surgery (ERAS) programme for colorectal cancer surgery [J]. Tech Coloproctol, 2014, 18(11):1075-1080.
[22]
黎介寿. 营养支持治疗与加速康复外科 [J]. 肠外与肠内营养, 2015, 22(2):65-67.
[23]
Martindale RG, Mcclave SA, Taylor B, et al. Perioperative nutrition: what is the current landscape? [J]. JPEN J Parenter Enteral Nutr, 2013, 37(5 Suppl):5S-20S.
[24]
Shussman N, Wexner SD. Current status of laparoscopy for the treatment of rectal cancer [J]. World J Gastroenterol, 2014, 20(41):15125-15134.
[25]
Smith JJ, Garcia-Aguilar J. Advances and challenges in treatment of locally advanced rectal cancer [J]. J Clin Oncol, 2015, 33(16):1797-1808.
[26]
Bonjer HJ, Deijen CL, Abis GA, et al. A randomized trial of laparoscopic versus open surgery for rectal cancer [J]. N Engl J Med, 2015, 372(14):1324-1332.
[27]
Fleshman J, Branda M, Sargent DJ, et al. Effect of Laparoscopic-Assisted Resection vs Open Resection of Stage II or III Rectal Cancer on Pathologic Outcomes: The ACOSOG Z6051 Randomized Clinical Trial [J]. JAMA, 2015, 314(13):1346-1355.
[28]
Stevenson AR, Solomon MJ, Lumley JW, et al. Effect of Laparoscopic-Assisted Resection vs Open Resection on Pathological Outcomes in Rectal Cancer: The ALaCaRT Randomized Clinical Trial [J]. JAMA, 2015, 314(13):1356-1363.
[29]
王锡山. 结直肠肿瘤微创外科的进展 [J]. 中华胃肠外科杂志, 2016, 19(6):621-623.
[30]
Khan S, Gatt M, Macfie J. Enhanced recovery programmes and colorectal surgery: does the laparoscope confer additional advantages? [J]. Colorectal Dis, 2009, 11(9):902-908.
[31]
Vlug MS, Wind J, Hollmann MW, et al. Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study) [J]. Ann Surg, 2011, 254(6):868-875.
[32]
Dhruva RP, Howells S, Haray PN. Does an enhanced recovery programme add value to laparoscopic colorectal resections? [J]. Int J Colorectal Dis, 2015, 30(11):1473-1477.
[33]
Kennedy RH, Francis EA, Wharton R, et al. Multicenter randomized controlled trial of conventional versus laparoscopic surgery for colorectal cancer within an enhanced recovery programme: EnROL [J]. J Clin Oncol, 2014, 32(17):1804-1811.
[34]
Khreiss W, Huebner M, Cima RR, et al. Improving conventional recovery with enhanced recovery in minimally invasive surgery for rectal cancer [J]. Dis Colon Rectum, 2014, 57(5):557-563.
[35]
Wang G, Jiang Z, Zhao K, et al. Immunologic response after laparoscopic colon cancer operation within an enhanced recovery program [J]. J Gastrointest Surg, 2012, 16(7):1379-1388.
[36]
van der Bij GJ, Oosterling SJ, Beelen RH, et al. The perioperative period is an underutilized window of therapeutic opportunity in patients with colorectal cancer [J]. Ann Surg, 2009, 249(5):727-734.
[37]
Feng J, Li K, Li L, et al. The effects of fast-track surgery on inflammation and immunity in patients undergoing colorectal surgery [J]. Int J Colorectal Dis, 2016, 31(10):1675-1682.
[38]
Chen WK, Ren L, Wei Y, et al. General anesthesia combined with epidural anesthesia ameliorates the effect of fast-track surgery by mitigating immunosuppression and facilitating intestinal functional recovery in colon cancer patients [J]. Int J Colorectal Dis, 2015, 30(4):475-481.
[39]
Gustafsson UO, Oppelstrup H, Thorell A, et al. Adherence to the ERAS protocol is Associated with 5-Year Survival After Colorectal Cancer Surgery: A Retrospective Cohort Study [J]. World J Surg, 2016, 40(7):1741-1747.
[40]
Asklid D, Segelman J, Gedda C, et al. The impact of perioperative fluid therapy on short-term outcomes and 5-year survival among patients undergoing colorectal cancer surgery - A prospective cohort study within an ERAS protocol [J]. Eur J Surg Oncol, 2017, 43(8):1433-1439.
[1] 张翼飞, 郭强, 赖华健, 钟文文, 叶雷, 马波, 瞿虎, 尧冰, 邱剑光, 王德娟. 加速康复外科在儿童尿道下裂围术期的应用效果分析[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(04): 367-371.
[2] 郑华蓉, 刘俊, 郑艳, 陈玉莲, 廖子敏. 加速康复外科理念下的集束化护理模式在腹股沟疝修补术中的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(05): 643-646.
[3] 贾雪敏, 刘海元. 预康复研究进展[J]. 中华腔镜外科杂志(电子版), 2023, 16(04): 252-256.
[4] 吕瑶, 张婵, 陈建华, 张鸣青. 压力控制容量保证通气模式在腹腔镜肝细胞癌切除术中的应用[J]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 528-533.
[5] 陈润芝, 杨东梅, 徐慧婷. 信迪利单抗联合索凡替尼后线治疗MSS型BRAF突变的转移性结肠癌:个案报道并文献复习[J]. 中华结直肠疾病电子杂志, 2023, 12(05): 431-435.
[6] 鄂一民, 孙司正, 范小彧, 喻春钊. 结直肠癌粪便筛查的现状与展望[J]. 中华结直肠疾病电子杂志, 2023, 12(04): 331-336.
[7] 中华医学会骨科分会关节学组. 中国髋、膝关节置换日间手术围手术期管理专家共识[J]. 中华老年骨科与康复电子杂志, 2023, 09(06): 321-332.
[8] 王小娜, 谭微, 李悦, 姜文艳. 预测性护理对结直肠癌根治术患者围手术期生活质量、情绪及并发症的影响[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 525-529.
[9] 梁文龙, 曹杰, 黄庆, 林泳, 黄红丽, 杨平, 李冠炜, 胡鹤. 信迪利单抗联合瑞戈非尼治疗晚期结直肠癌的疗效与安全性分析[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 409-413.
[10] 刘代江, 蒋俊艳, 万晓强, 马莎英. 结直肠癌肝转移患者生存状况及预后影响因素分析[J]. 中华消化病与影像杂志(电子版), 2023, 13(05): 284-288.
[11] 李永胜, 孙家和, 郭书伟, 卢义康, 刘洪洲. 高龄结直肠癌患者根治术后短期并发症及其影响因素[J]. 中华临床医师杂志(电子版), 2023, 17(9): 962-967.
[12] 王飞飞, 王光林, 孟泽松, 李保坤, 曹龙飞, 张娟, 周超熙, 丁源一, 王贵英. 敲低IMPDH1对结肠癌SW480、HT29细胞生物功能的影响[J]. 中华临床医师杂志(电子版), 2023, 17(08): 884-890.
[13] 孔凡彪, 杨建荣. 肝脏基础疾病与结直肠癌肝转移之间关系的研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(07): 818-822.
[14] 王亚丹, 吴静, 黄博洋, 王苗苗, 郭春梅, 宿慧, 王沧海, 王静, 丁鹏鹏, 刘红. 白光内镜下结直肠肿瘤性质预测模型的构建与验证[J]. 中华临床医师杂志(电子版), 2023, 17(06): 655-661.
[15] 王延召, 牛鹏飞, 丁长民, 高庆坤, 高兆亚, 安柯, 翟志超, 曾庆敏, 黄文生, 雷福明, 顾晋. 结直肠癌致腹壁巨大缺损的一期修补经验(附13例报告)[J]. 中华临床医师杂志(电子版), 2023, 17(05): 557-561.
阅读次数
全文


摘要