Enhanced recovery after surgery (ERAS) and fast-track in video-assisted thoracic surgery (VATS) lobectomy: preoperative optimisation and care-plans

Abstract

Main specific interventions for preoperative clinical optimisation of patients undergoing lung cancer surgery include assessment and treatment of comorbidities, minimizing preoperative hospitalization, minimizing preoperative fasting, and optimisation of antibiotic and thrombo-embolic prophylaxis. Preoperative patient optimisation is considered a crucial part of enhanced recovery after thoracic surgery pathways. Potentially, advantages of this fast-track management could be even higher when considering video-assisted thoracic surgery (VATS) major lung resection, because reduced trauma related to minimally invasive techniques is one of the main factors improving postoperative outcome. Literature data and clinical evidences in this setting are reported and discussed.

Prepyloric gastric inflammatory fibroid polyp presenting as chronic epigastric discomfort in a 5th decade aged female: A case report

“…Size at initial diagnosis varies widely and may reach 12 cm, ranging between 2–5 cm mainly. Its accurate pathogenesis is unknown, but is described to be due to an irritating agent (Helicobacter Pylori, metabolic factors, parasites) leading to a benign reactive lesion [ 2 ]. It usually arise between the deep gastric mucosa and the submucosa without passing the muscularis propria [ 5 ].…”

“…It is first described by dr Konjetzny in 1920 as a fibromatous polyp, then in 1949 by Dr Vanek as a granulomatous eosinophilic submucosal lesion, and lastly by Drs Helwig and Ranier in 1953 assigning it by its present name [ 1 ]. It occurs mostly in the gastric antrum and presents 0.1% of all gastric polyps [ 2 ].…”

“…Although mostly asymptomatic, symptoms are nonspecific, the diagnosis can be reached by using Endoscopy, Echo-Endoscopy (EE) and Computed Tomography (CT) scan of Abdomen and pelvis, but final diagnosis is only reached in 10% of cases before resection which is the mainstay in the treatment and can be accomplished surgically or endoscopically [ 2 ].…”

Anesthetists and surgeons in ensuring preoperative optimization

“…ERAS aims to maintain the physiological functions of the individual and to ensure early mobilization in the postoperative period by reducing the intensity of the physical and psychological stress associated with the respective surgery 1,3 . A general preoperative evaluation is required for all patients, who will undergo elective surgery, in order to determine if the scheduled intervention will be appropriate for the particular patient 3 .…”

“…"Enhanced Recovery After Surgery" (ERAS) is a set of evidence-based care pathways performed by a multidisciplinary professional healthcare team in order to assist patients in achieving a faster recovery in the postoperative period 1 . It has been proven that perioperative complication rates, morbidity, the length of hospital stay, and cost of hospitalization are reduced by the implementation of ERAS protocols 2,3 . ERAS protocol comprises multiple components, including preoperative optimization 1 .…”