Esophageal Cancer Clinical Pathway
I. Esophageal cancer clinical pathway standard hospitalization process
(I) Applicable objects.
The first diagnosis is esophageal cancer
Radical esophageal cancer surgery (esophageal cancer resection + esophagogastric anastomosis)
(B) Diagnostic basis.
According to the Clinical Diagnosis and Treatment Guide-Thoracic Surgery Book (compiled by Chinese Medical Association, People’s Health Publishing House)
1. Clinical symptoms: progressive dysphagia.
2.Auxiliary examination: barium meal of upper gastrointestinal tract, endoscopy and biopsy suggestion.
(C) Selection of treatment plan.
According to the Clinical Diagnosis and Treatment Guide-Thoracic Surgery Sub-volume (edited by Chinese Medical Association, People’s Health Publishing House)
1.Esophageal cancer resection via the left chest, intrathoracic esophagogastric anastomosis or cervical esophagogastric anastomosis.
2.Esophageal cancer resection through the right chest, intrathoracic esophagogastric anastomosis (two incisions in the chest and abdomen) or cervical anastomosis (three incisions in the neck, chest and abdomen).
(D) The standard hospitalization days are 13-21 days.
(E) Entry pathway criteria.
1.The first diagnosis must be in accordance with ICD-10: C15/D00, 1 esophageal cancer disease code.
2.When the patient has other disease diagnoses at the same time, but no special treatment is needed during hospitalization nor does it affect the implementation of the clinical pathway process of the first diagnosis, he/she can enter this pathway.
(F) Preoperative preparation (preoperative evaluation) 3-5 days.
1. Required examination items.
(1) Routine blood, routine urine, and routine stool.
(2) Coagulation function, blood group, liver and kidney function, electrolytes, infectious disease screening (hepatitis B, hepatitis C, AIDS, syphilis, etc.).
(3) pulmonary function, blood gas analysis, electrocardiogram.
(4) Endoscopy + biopsy.
(5) Imaging: front and side chest radiographs, upper gastrointestinal tract imaging, chest CT (plain + enhanced scan), abdominal ultrasound or CT.
2. Depending on the patient’s condition, the following options are available.
(1) Echocardiography.
(2) Esophageal endoscopic ultrasound, etc.
(vii) Prophylactic antimicrobial drug selection and timing of use.
1.Antimicrobial drugs: should be implemented in accordance with the “Guidelines for Clinical Application of Antimicrobial Drugs” (Health Medical Development [2004] No. 285), and the rational use of antimicrobial drugs according to the patient’s condition.
2.Pre-operative 30 minutes prophylactic application of antimicrobial drugs.
(H) The day of surgery is the 3rd-7th day of hospital admission.
1.Anesthesia mode: general anesthesia with double-lumen tracheal intubation.
2.Surgical consumables: used according to the patient’s condition (circular anastomosis, closure device, cutting and suturing device, etc.).
3.Intraoperative medication: prophylactic application of antibacterial drugs.
4.Blood transfusion: depending on the intraoperative condition.
(ix) Postoperative hospital recovery for 10-14 days.
1.Checkup items that must be reviewed: chest X-ray, blood routine, liver and kidney function, electrolytes.
2. Postoperative medication: antibacterial drugs should be used in accordance with the Guidelines for the Clinical Application of Antibacterial Drugs (Wei Medical Development [2004] No. 285), and second-generation cephalosporins or combined application of metronidazole may be used.
(X) Discharge criteria.
1, into semi-liquid food smoothly.
2, good healing of the incision, or poorly healed incision that can be handled in the outpatient clinic.
3, normal body temperature, chest X-ray suggests no obvious signs of infection.
(XI) Variation and cause analysis.
1, There are comorbidities affecting the surgery, and relevant diagnosis and treatment are required.
2.Postoperative complications such as pulmonary infection, respiratory failure, cardiac failure, anastomotic fistula, etc. need to extend the treatment time.
II. Clinical pathway of esophageal cancer
Applicable objects: The first diagnosis of esophageal cancer
Radical esophageal cancer surgery (esophageal cancer resection + esophagogastric anastomosis)