Esophageal Adenocarcinoma Methods and Protocols

46

●● Chest physiotherapy is instituted and early ambulation encour-

aged. Deep vein thrombosis prophylaxis is continued.

●● Chest drain is removed on day 4–5 post-operation, the daily

output should be less than 200–300 ml per day.

Table 1
Proposed protocol of perioperative management for esophagectomy

Preoperative

Preoperative counseling

Nutritional assessment Nasogastric tube feeding or oral supplement in those

at risk of malnutrition

Preoperative exercise General and incentive spirometry

Stop smoking and alcohol intake

Chest physiotherapy

Carbohydrate loading on day of

surgery

No solid food 6 h before and fluid 2 h before surgery.

Carbohydrate loading night before and finishes

2 h before surgery

Intraoperative

DVT prophylaxis Mechanical ± pharmacological

Judicious use of intraoperative fluid

Avoid hypothermia

Minimally invasive surgery if possible

Epidural analgesia

Postoperative

Nutrition POD1 carbohydrate drink, gradual advancement

to soft diet by POD5

PPN/TPN in those at nutritional risk and oral intake

insufficient

Nasogastric tube Removal on POD 1

Analgesia Epidural analgesia/patient-controlled analgesia

Chest drain Single closed drain, removal POD 3–4 when output

<200–300 ml per day

Early mobilization

Urinary catheter Early removal as soon as close monitoring of urine

output is not essential

Intravenous fluid Balanced intravenous fluid to avoid over- and under-hydration

DVT prophylaxis

DVT deep vein thrombosis
POD post-operation day
PPN/TPN peripheral parenteral nutrition/total parenteral nutrition

Simon Law