講演情報
[AS1-3]ERAS and Impact of Dietary Intervention in Patients before and after Colorectal Cancer Surgery
Fumihiko Fujita, Takahiro Shigaki, Kenji Fujiyoshi, Naohiro Yoshida, Kenichi Koushi, Takefumi Yoshida (Department of Surgery, Kurume University School of Medicine)
The ERAS protocol has been widely reported to be useful in perioperative management, including reducing the incidence of postoperative complications and shortening the length of hospital stay. In Japan, however, the ERAS protocol has not yet fully permeated perioperative management, particularly in colorectal surgery. One of the reasons may be that some surgeons may be reluctant to skip preoperative mechanical bowel preparation especially in left-sided colon and rectal surgery. Especially in rectal surgery, the management of the patient with fasting after surgery may prevent anastomotic leakage.The best approach might be to adhere to the important elements of ERAS protocol and start in a way that suits each institution. In Japan, Kampo medicine, a form of traditional Eastern medicine, is also commonly used. And considering its effects, Kampo medicine might be utilized during the perioperative period. In the Kampo medicine, Daikenchuto（TJ-100）is the one of the representative medicines, and it is commonly used for treatment of constipation or ileus. TJ-100 is also known for increasing portal blood flow, and we have developed a hypothesis based on the effects of TJ-100. If TJ-100 increases portal blood flow, then more nutrients would be absorbed from the intestines. Twenty patients who underwent colorectal cancer surgery were enrolled in our study, and they were randomly divided into a group that received TJ-100 during the perioperative period and a group that did not. Then, the perioperative nutritional status of each group was compared. The results showed that TJ-100 has been suggested to potentially reduce postoperative weight loss when used during the perioperative period of colorectal surgery. In the ERAS protocol for colorectal cancer surgery, we should actively adhere to the essential items which are recommended by ERAS society and it is also important to make improvements based on evidence.