Fast track clinical pathway implications in esophagogastrectomy

To investigate the feasibility of fast track clinical pathway for esophageal tumor resections.

One hundred and fourteen patients with esophageal carcinoma who underwent esophagogastrectomy from January 2006 to October 2007 in our department were studied. Fast track clinical pathway included analgesia control, fluid infusion volume control, early ambulation and enteral nutrition. Nasogastric tube was removed 3 d after operation and chest tube was removed 4 d after operation as a routine, and full liquid diet 5 d after operation.

Among 114 patients (84 men and 30 women), 26 patients underwent fast track surgery, including 17 patients over 65 years old and 9 under 65 (P=0.014); 18 patients who had preoperative complications could not bear fast track surgery (P<0.001). No significant differences in tolerance of fast track surgery were attributed to differences in gender, differentiated degree or stage of tumor, pathological type of tumor, or operative incision. The median length of hospital stay was 7 d (5-28 d), 4% patients were readmitted to hospital within 30 d of discharge. Three patients died and postoperative mortality was 2.6%. All 3 patients had no determinacy to fast track surgery approach.

The majority of patients with esophageal carcinoma can tolerate fast track surgery. Patients younger than 65 or who have no preoperative diseases have the best results. Median length of hospital stay has been reduced to 7 d.