[EARLY AMBULATION AFTER SURGERY AND PERIOPERATIVE REHABILITATION]

Early ambulation following a surgical procedure is a central concept in fast-track surgery according to Enhanced Recovery after Surgery protocols. Although a shorter hospital stay is reported to be a benefit of perioperative rehabilitation, its effect on patient metabolism has not been fully explored. Thirty-eight patients who had undergone esophagectomy, a highly stressful surgery, received intensive rehabilitation (group R) with regular evaluation of their metabolic parameters compared with 41 control group patients (group C) who received conventional care without such rehabilitation. Nitrogen balances calculated daily were significantly higher in group R on the third postoperative day. Fluid retention after surgery improved earlier in group R than in group C. Liver dysfunction occurred 1 week after surgery in group C but was avoided in group R. Total lymphocyte counts decreased after surgery in both groups, but their recovery was observed earlier in group R. Early mobility after esophagectomy is thought to avoid disuse atrophy of skeletal muscles in postsurgical patients. Fluid retention and immune dysfunction are also improved through perioperative rehabilitation. The biological mechanisms underlying the benefits of rehabilitation should be further elucidated for its clinical application in all surgical care pathways.