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Application of ERAS protocol in esophagectomy: a national survey among Italian centers performing esophageal surgery

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Abstract

The application of enhanced recovery after surgery guidelines for esophageal surgery in different units remains unclear. This survey intended to investigate how such protocol is applied among Italian esophageal surgery units. A survey with 40 questions was mailed to Italian centers that performed at least 10 esophagectomies per year. It included questions about the type of hospital and unit and pre-, intra- and post-operative items. Difficulties encountered were investigated. Thirteen (65%) centers answered the survey, and all met the minimal safety requirements, e.g., the presence of intensive care units and 24-h on-call operative endoscopy and radiology facilities. Fifty percent of esophagectomies with a minimally invasive approach were performed in 84.6% of the centers. Regarding pre-operative items, the highest scores were for the application of nutritional support, dysphagia palliation and presence of a multidisciplinary tumor board, whereas the lowest score was for the use of immunonutrition. Regarding intra-operative items, hypothermia prevention and the use of goal-directed fluid therapy and volatile anesthesia were diffusely adopted, whereas the rate of using abdominal drains was high. Regarding post-operative items, nausea prevention, multimodal analgesia and early mobilization were applied frequently, whereas the use of nasogastric tubes and regular transfer to intensive care units was diffused. The primary barriers in enhanced recovery after surgery protocol application were resistance and a lack of paramedic personnel. This survey’s results highlight the efforts undertaken by several centers to apply enhanced recovery after surgery philosophy and in this regard, demonstrate a good standing in Italy.

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Data accessibility statement

The conducted research was not preregistered with an analysis plan in an independent, institutional registry. We are not archiving extra data in a public repository. All data available are shown along the present manuscript.

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Acknowledgements

We would like to thank Editage (http://www.editage.com) for English language editing.

The Italian Society for Study of Diseases of the Esophagus: Bonavina Luigi: General Surgery Unit, IRCCS Policlinico San Donato, Milan, Borghi Felice: General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, Cuneo, Coratti Andrea: Oncologic and Robotic Surgery Unit, Careggi University Hospital of Florence, De Manzoni Giovanni: General, Esophageal and Gastric Surgery Unit, University Hospital of Verona, De Pascale Stefano: Digestive Surgery, European Institute of Oncology, IRCCS, Milan, Ferrari Giovanni: Minimally-Invasive Oncologic General Surgery Unit, Niguarda Hospital, Fumagalli Romario Uberto: Digestive Surgery, European Institute of Oncology, IRCCS, Milan, Giacopuzzi Simone: General, Esophageal and Gastric Surgery Unit, University Hospital of Verona, Gualtierotti Monica: Minimally-Invasive Oncologic General Surgery Unit, Niguarda Hospital, Mattioli Sandro: General and Thoracic Surgery Unit, Maria Cecilia Hospital, Cotignola, Merigliano Stefano: 3rd Surgical Clinic, University Hospital of Padova, Morino Mario: 1st General Surgery Unit, Le Molinette University Hospital, Turin, Pallabazzer Giovanni: Esophageal Surgery Unit, University Hospital of Pisa, Peri Andrea: 2nd General Surgery Unit, San Matteo Policlinic Hospital, Pavia, Petri Roberto: General Surgery Unit, University Hospital of Udine, Pietrabissa Andrea: 2nd General Surgery Unit, San Matteo Policlinic Hospital, Pavia, Rebecchi Fabrizio: 1st General Surgery Unit, Le Molinette University Hospital, Turin, Santi Stefano: Esophageal Surgery Unit, University Hospital of Pisa, Valmasoni Michele: 3rd Surgical Clinic, University Hospital of Padova, Weindelmayer Jacopo: General, Esophageal and Gastric Surgery Unit, University Hospital of Verona.

Funding

There has been no direct or indirect financial support by extramural sources.

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Authors and Affiliations

  1. Gastrointestinal Surgery Unit, San Raffaele Hospital, 60 Via Olgettina, 20132, Milan, Italy

    Paolo Parise, Eider Talavera-Urquijo, Agnese Carresi, Lavinia Barbieri, Andrea Cossu, Ugo Elmore, Francesco Puccetti & Riccardo Rosati

  2. Neurosurgery Intensive Care Unit, San Raffaele Hospital, Milan, Italy

    Stefano Turi

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  1. Paolo Parise
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  2. Stefano Turi
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  3. Eider Talavera-Urquijo
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  4. Agnese Carresi
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  5. Lavinia Barbieri
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  6. Andrea Cossu
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  7. Ugo Elmore
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  8. Francesco Puccetti
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Consortia

The Italian Society for Study of Diseases of the Esophagus

  • Bonavina Luigi
  • , Borghi Felice
  • , Coratti Andrea
  • , De Manzoni Giovanni
  • , De Pascale Stefano
  • , Ferrari Giovanni
  • , Fumagalli Romario Uberto
  • , Giacopuzzi Simone
  • , Gualtierotti Monica
  • , Mattioli Sandro
  • , Merigliano Stefano
  • , Morino Mario
  • , Pallabazzer Giovanni
  • , Peri Andrea
  • , Petri Roberto
  • , Pietrabissa Andrea
  • , Rebecchi Fabrizio
  • , Santi Stefano
  • , Valmasoni Michele
  •  & Weindelmayer Jacopo

Contributions

Every author has contributed to the article as listed below: 1. Designing the study: PP, AC, FP, UE, RR. 2. Collecting, analyzing, and interpreting the data: PP, ET-U, LB, AC. 3. Writing the report: PP, ST, ET-U. 4. Making the decision to submit for publication: PP, UE, RR.

Corresponding author

Correspondence to Paolo Parise.

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Conflict of interest

Parise Paolo, Turi Stefano, Talavera-Urquijo Eider, Carresi Agnese, Barbieri Lavinia, Cossu Andrea, Puccetti Francesco, and Rosati Riccardo have no conflicts of interest or financial ties to disclose.

Research involving human participants and/or animals

This work consisted in a survey filled on a voluntary basis by the collaborators attached to the title page. There have not been human and/or animal participants involved for the development of the study.

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An informed consent is not applicable for this type of work.

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The memebers of “The Italian Society for Study of Diseases of the Esophagus” are listed in “Acknowledgements” section.

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Parise, P., Turi, S., Talavera-Urquijo, E. et al. Application of ERAS protocol in esophagectomy: a national survey among Italian centers performing esophageal surgery. Updates Surg 73, 297–303 (2021). https://doi.org/10.1007/s13304-020-00963-8

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  • DOI: https://doi.org/10.1007/s13304-020-00963-8

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