Abstract
Background
A recent development in gastrointestinal surgery is the implementation of enhanced recovery after surgery (ERAS) programs. Evidence regarding the benefit of these programs in patients undergoing esophageal surgery is scarce. We investigated the feasibility and possible benefit of a perioperative ERAS program in patients undergoing esophagectomy for malignant disease.
Methods
The ERAS program was initiated in 2009. Patients who underwent esophagectomy and were treated according to the ERAS program were included. Items of ERAS included preoperative nutrition, early extubation, early removal of nasogastric tube, and early mobilization. Primary outcome parameters were hospital stay and the incidence of postoperative complications. Outcome parameters in the ERAS cohort were compared to a cohort of patients who underwent surgical resection in the year prior to the implementation of the ERAS protocol. A feasibility analysis was performed among a sample of ERAS patients to determine the number of achieved items per patient.
Results
Between 2008 and August 2010, 181 patients in our department underwent esophagectomy. Of these, 103 patients were included in the ERAS program (ERAS+ group) and were compared to 78 patients who had undergone an esophagectomy in 2008 (ERAS– group). Overall hospital stay was 14 days versus 15 days (ERAS+ and ERAS–, respectively; p = 0.013). There were no significant differences in the incidence of postoperative complications in either group. The percentage of achieved items varied between 42 and 93 % per item.
Conclusions
The implementation of an ERAS program in esophageal surgery was feasible and resulted in a small but significant reduction in overall hospital stay, whereas overall morbidity was not affected.
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References
Wilmore DW, Kehlet H (2001) Management of patients in fast track surgery. BMJ 322:473–476
Fearon KC, Ljungqvist O, Von MM et al (2005) Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 24:466–477
Gustafsson UO, Scott MJ, Schwenk W et al (2013) Guidelines for perioperative care in elective colonic surgery: enhanced recovery after surgery (ERAS((R))) society recommendations. World J Surg 37:259–284. doi:10.1007/s00268-012-1772-0
Lassen K, Soop M, Nygren J et al (2009) Consensus review of optimal perioperative care in colorectal surgery: enhanced recovery after surgery (ERAS) group recommendations. Arch Surg 144:961–969
Lassen K, Coolsen MM, Slim K et al (2013) Guidelines for perioperative care for Pancreaticoduodenectomy: enhanced recovery after surgery (ERAS((R))) society recommendations. World J Surg 37:240–258. doi:10.1007/s00268-012-1771-1
Chappell D, Jacob M (2010) Influence of non-ventilatory options on postoperative outcome. Best Pract Res Clin Anaesthesiol 24:267–281
Kehlet H (1997) Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 78:606–617
Spanjersberg WR, Reurings J, Keus F et al. (2011) Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev 2011; CD007635
Hulscher JB, van Sandick JW, de Boer AG et al (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347:1662–1669
Swisher SG, Deford L, Merriman KW et al (2000) Effect of operative volume on morbidity, mortality, and hospital use after esophagectomy for cancer. J Thorac Cardiovasc Surg 119:1126–1132
van Heijl M, van Lanschot JJ, Blom RL et al. (2010) [Outcomes of 16 years of oesophageal surgery: low postoperative mortality and improved long-term survival]. Ned Tijdschr Geneeskd 154: A1156 (in Dutch)
Hofstetter W, Swisher SG, Correa AM et al (2002) Treatment outcomes of resected esophageal cancer. Ann Surg 236:376–384
Karl RC, Schreiber R, Boulware D et al (2000) Factors affecting morbidity, mortality, and survival in patients undergoing Ivor Lewis esophagogastrectomy. Ann Surg 231:635–643
Cerfolio RJ, Bryant AS, Bass CS et al (2004) Fast tracking after Ivor Lewis esophagogastrectomy. Chest 126:1187–1194
Munitiz V, Martinez-de-Haro LF, Ortiz A et al (2010) Effectiveness of a written clinical pathway for enhanced recovery after transthoracic (Ivor Lewis) oesophagectomy. Br J Surg 97:714–718
van Heijl M, van Lanschot JJ, Koppert LB et al (2009) Neoadjuvant chemoradiation followed by surgery versus surgery alone for patients with adenocarcinoma or squamous cell carcinoma of the esophagus (CROSS). BMC Surg 8:21
Vlug MS, Wind J, Hollmann MW et al (2011) Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study). Ann Surg 254:868–875
Caumo W, Hidalgo MP, Schmidt AP et al (2002) Effect of pre-operative anxiolysis on postoperative pain response in patients undergoing total abdominal hysterectomy. Anaesthesia 57:740–746
Lewis SJ, Andersen HK, Thomas S (2009) Early enteral nutrition within 24 h of intestinal surgery versus later commencement of feeding: a systematic review and meta-analysis. J Gastrointest Surg 13:569–575
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Blom, R.L.G.M., van Heijl, M., Bemelman, W.A. et al. Initial Experiences of an Enhanced Recovery Protocol in Esophageal Surgery. World J Surg 37, 2372–2378 (2013). https://doi.org/10.1007/s00268-013-2135-1
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DOI: https://doi.org/10.1007/s00268-013-2135-1