THE CLINICAL PATHWAY FOR FREE JEJUNUM RECONSTRUCTION IN SHIZUOKA CANCER CENTER HOSPITAL

Abstract

We report our method of perioperative management under clinical pathway for laryngopharyngoesophagectomy with free jejunum reconstruction. We treated 44 patients diagnosed as hypopharyngeal carcinoma between 2002 and 2005. Thirty-six of them were treated under clinical pathway. Variances were assessed and the clinical pathway was improved twice. Comparing the cases before improving the clinical pathway (17 patients) those after improvement (7 patients), the period until start of walking was shortened from 4 days to 2 days. The period until start of peroral nutrition was also shortened from 9 days to 7 days. Caloric intake of each patient increased from 1045 kcal/day to 1388 kcal/day. Patients who deviated from clinical pathway management decreased from 41% to 14%. Clinical pathway combined with an electronic medical record system was highly effective for an interdisciplinary medical team approach.