Retrospective cohort study of an enhanced recovery programme in oesophageal and gastric cancer surgery

Abstract

INTRODUCTION Enhanced recovery programmes have been established in some areas of elective surgery. This study applied enhanced recovery principles to elective oesophageal and gastric cancer surgery. METHODS An enhanced recovery programme for patients undergoing open oesophagogastrectomy, total and subtotal gastrectomy for oesophageal and gastric malignancy was designed. A retrospective cohort study compared length of stay on the critical care unit (CCU), total length of inpatient stay, rates of complications and in-hospital mortality prior to (35 patients) and following (27 patients) implementation. RESULTS In the cohort study, the median total length of stay was reduced by 3 days following oesophagogastrectomy and total gastrectomy. The median length of stay on the CCU remained the same for all patients. The rates of complications and mortality were the same. CONCLUSIONS The standardised protocol reduced the median overall length of stay but did not reduce CCU stay. Enhanced recovery principles can be applied to patients undergoing major oesophagogastrectomy and total gastrectomy as long as they have minimal or reversible co-morbidity. KEYWORDSGastric neoplasms -Oesophageal neoplasms -Surgical procedures -Perioperative careEnhanced recovery Accepted 24 January 2015 CORRESPONDENCE TO Piers Gatenby, E: p.gatenby@ucl.ac.uk Enhanced recovery after surgery (ERAS) or fast track programmes have been well established in elective surgery for colorectal resections and joint replacement.1-6 These programmes benefit patients, healthcare providers and those commissioning healthcare by providing earlier recovery with faster return to normal activity as well as improvement in quality of care, productivity, consistency and patient experience with innovative and efficient multidisciplinary practice. 7 The aim of this study was to examine the approach to and outcomes of the implementation of an ERAS programme in a group of patients admitted for open oesophageal and gastric resections for adenocarcinoma under a single upper gastrointestinal surgeon at a tertiary referral centre. MethodsA retrospective audit was performed of the periods prior to (control group) and following (intervention group) the implementation of an ERAS pathway. The study was undertaken in a specialist cancer centre that serves a population of 1.6 million, receiving over 350 new oesophagogastric referrals, and performing approximately 75 oesophageal and gastric resections annually. All patients involved in the study were under the care of a single oesophagogastric surgeon (WHA). The control cohort consisted of all patients undergoing surgery between 1 January and 31 December 2009. The intervention was then implemented over a three-month period and the intervention cohort comprised all patients from 1 April 2010 to 31 March 2011. Demographic data on age and sex, and use of preoperative chemotherapy were recorded.Following the introduction of the intervention, all patients who were fit enough for surgery proceeded along the ERAS pathway as the default...

The Development, Application and Analysis of an Enhanced Recovery Programme for Major Oesophagogastric Resection

“…These were predominantly reports of single surgeon series and open resections 4. In some units, one surgeon but not others have embraced ERAS for oesophageal surgery5, and in other units, only the fittest patients have been included, making the overall benefits hard to establish 6…”

Is closed thoracic drainage tube necessary for minimally invasive thoracoscopic-esophagectomy?

“…Regardless the development of MIE in esophageal cancer, patient with esophageal squamous carcinoma still forced to go through a series of dangerous perioperative treatment and terrible experience with less post-operative satisfaction (1,12). Since the fast-track surgery (FTS) was introduced to esophageal surgery by Cerfolio et al (13,14), few studies focused on the role in esophageal surgery practice.…”

Multicomponent hospital-led interventions to reduce hospital stay for older adults following elective surgery: a systematic review

“…Of the 73 prioritised studies (reported in 80 articles), 39 (40 articles) were conducted in the UK, 31,191,192,194,195,197,201,203,[205][206][207][208]210,212,213,215,216,218,224,226,[228][229][230][231][232][236][237][238]241,244,245,250,253,256,257,259,260,262,263,269 13 of which were RCTs. Thirty-four (41 articles) were RCTs conducted in one of 15 other countries, the most common of which were six studies from Germany, 202,217,227,240,[246][247][248][249]…”

“…Thirty-four (41 articles) were RCTs conducted in one of 15 other countries, the most common of which were six studies from Germany, 202,217,227,240,[246][247][248][249]255 five from the Netherlands, 204,[219][220][221]265,266,268 four from Denmark 196,225,233,234,267 and four from Canada. 193,198,200,214 The remaining studies consisted of 24 uncontrolled before-and-after (UBA) trials 191,194,195,197,201,203,[206][207][208]212,216,218,228,230,232,237,238,241,245,250,253,257,262,…”