3．食道癌治療におけるESSENSEの理念と周術期管理

ESSENSE Concept and Perioperative Management in Esophageal Cancer Treatment

生体が手術侵襲で受けたダメージからより早く回復をめざすことは，術後管理の最大の目標である．周術期管理では，術前，術中，術後の各々の期間において適切な管理が行われていなければ，結果としてより早い手術からの回復は望めない．このことはきわめて当然のことではあるが，よく理解しておく必要がある．

The actual operation based on the philosophy of ESsential Strategy for Early Normalization after Surgery with patient’s Excellent satisfaction （ESSENSE） in radical thoracic esophageal cancer surgery is described. ESSENSE, which is proposed by the Japanese Society of Surgical Metabolism and Nutrition to promote postoperative recovery, consists of four principles：reduction of invasive reactions, early independence of physical activity, early independence of nutrition intake, and perioperative anxiety reduction and motivation for recovery. Here, we describe the actual operation based on the ESSENSE philosophy in radical thoracic esophageal cancer surgery, which is classified as one of the highly invasive esophageal cancer surgeries. We have been performing perioperative management using the above protocol since April 2012. The outcomes of 334 patients up to April 2020 are described. Preoperative chemotherapy was administered in 74％ of patients, 70％ underwent thoracoscopic surgery, 50％ had Clavien-DindoⅡ or higher postoperative complications, and 14％ had postoperative pneumonia. The mean postoperative bed rest was 1.6 days. This contributed to a shorter hospital stay and fewer pulmonary complications compared with previous management. The four principles of ESSENSE are useful for early recovery programs in Japan. The ESSENSE should be implemented from this perspective according to the disease, medical facility, community, and family situation.