Effects of improving outcomes after esophagectomy on the short- and long-term: a review of literature

Abstract

An esophagectomy is still correlated with a high morbidity rate, despite advances made in minimally invasive surgery, enhanced recovery after surgery (ERAS) and centralization of this type of surgery. The short-term benefits are clearly described for esophageal cancer surgery patients, however, the longterm effects are yet to be determined. In colorectal cancer, the association between complications, especially anastomotic leakage, shows detrimental effects on long-term survival and cancer recurrence. In esophageal cancer surgery, current evidence is scarce and the described results are conflicting. Optimization of perioperative care by introduction of minimally invasive surgery, ERAS programs and patient prehabilitation is promising and shows a clear effect on short-term outcomes. Potentially, this may also result in better outcomes on the long-term, although current evidence is insufficient to infer definite conclusions. Reduction of anastomotic leakage seems important to reduce risk of cancer recurrence and improve long-term outcome.

The Influence of Pretherapeutic and Preoperative Sarcopenia on Short-Term Outcome after Esophagectomy

“…It also has been shown that standardized protocols like ERAS protocols for surgical cancer patients lead to shorter in-hospital stays, decreased complications and longer overall survival [ 31 , 32 , 33 , 51 ]. Therefore, our clinic uses standardized pathways for esophageal cancer patients to improve postoperative outcomes of esophageal cancer patients.…”

“…Due to these findings the oncological patients at the Surgical Department of the University Hospital Mannheim are encouraged to take part in nutritional consulting at our clinic or at other specialized practices before and after surgery. Our clinic uses standardized protocols, guided by “Enhanced recovery after surgery“(ERAS) protocols, to improve postoperative outcome and length of hospital stay [ 30 , 31 , 32 , 33 ].…”

The Association of Textbook Outcome and Long-Term Survival After Esophagectomy for Esophageal Cancer

“…17,18 During the study period, multiple modifications were made to the perioperative care path to improve outcomes after esophagectomy, such as centralization of care and introduction of enhanced recovery after surgery programs. 19 The effect of these modifications is reflected by an increase in "no severe postoperative complications" (Figure 2). Subsequently, reduction of complications after esophagectomy could also improve long-term survival.…”

Late-course accelerated Hyperfractionation vs. Conventional Fraction Radiotherapy under precise technology plus Concurrent Chemotherapy for Esophageal Squamous Cell Carcinoma: comparison of efficacy and side effects

“…Although surgery is an effective treatment for EC, most patients tend to be at an advanced stage at the time of diagnosis [5,6]. Thus, radiotherapy (RT) plays a well-defined role in the management of patients with inoperable locally advanced EC [7].…”