Journal of thoracic disease
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Fast track is a standardised goal directed patient's care pathway that aims to facilitate recovery following surgery. Currently, there are large variations in the fast track protocols used in oesophagectomy due to the complexity of the procedure. The objective of this systematic review is to assess the evolution of fast track protocols following oesophagectomy since its implementation and the resulting effect on postoperative outcomes. ⋯ Thirty publications were included that evaluated specific components of fast track protocols, with an increasing trend towards addressing the nutritional aspect in oesophagectomy care in more recent years. The variations in the key components of fast track protocol of care identify the need for continued assessment and identification for areas of improvement. In the future incremental gains through focused improvements in key components will lend itself to even better postoperative outcomes and patient experience during oesophageal cancer treatment.
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Esophagectomy remains the mainstay treatment of esophageal cancer (EC). Combined with neoadjuvant therapies, the management of EC has deleterious effects on body composition, functional capacity and psychological well-being. Preoperative patient optimisation known as prehabilitation is a novel intervention aimed at reducing morbidity and mortality associated with the trajectory of EC care. ⋯ Nutritional and psychological interventions are less well evaluated. Furthermore, no convincing relationship between prehabilitation and oncological outcomes has been demonstrated. Early studies evaluating prehabilitation are promising however further large scale research is required in order to assess the clinical effectiveness.
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There is no doubt that in recent years our profession has witnessed a steady increase in the number of complaints it receives regarding patient treatment. Patients and families raise such complaints having considered that the treatment offered by clinicians was substandard. Although many of these are resolved with direct correspondence from the hospital and meetings, several others lead to legal proceedings. ⋯ It is then obvious that the role of clinicians as medical expects becomes vital. In fact, their true role is of paramount importance not so much for the successful outcome of a case but mainly for the provision of justice for both claimants and defendants. The article will try and identify the challenges that medical experts face in the current litigation climate and with the opinion of a thoracic surgery expert, will tease out important elements which are necessary to drive a modern and safe clinical and medico legal practice.