State of the art of enhanced recovery after surgery (ERAS) protocols in esophagogastric cancer surgery: the Western experience

Abstract

Enhanced recovery after surgery programs provide a framework to standardize care processes and improve outcomes. The results of this multimodal and multidisciplinary approach have been beneficial across several surgical procedures in reducing morbidity and hospital stay without increasing readmissions.The implementation of these programs in esophagogastric cancer surgery has been challenging due to the complexity of both procedures and the high risk of complications, with most of the evidence coming from the East. Despite the limited evidence for ERAS in esophageal surgery in Western centers, systematic reviews and meta-analysis have confirmed that ERAS programs reduce pulmonary complications and hospital stay after esophagectomy without increasing readmissions. Single-center Western studies have shown that implementing gastrectomy ERAS protocols resulted in a reduction of the use of nasogastric tube and intrabdominal drains, accelerated advancement of diet and reduced length of stay, without increasing complications. Despite these beneficial outcomes, it has become clear that there has been wide heterogeneity and absence of standardization in the number and definition of the ERAS components. The development of ERAS consensus guidelines including procedure-specific components may reduce this variability.Regardless of growing evidence of effectiveness, adherence to ERAS protocols in esophagogastric surgery remains challenging and had great variability with a wide adherence rate (5.6-100%) for single item.As initial experiences have demonstrated to be so beneficial, an implementation of the protocols with multidisciplinary team engagement and feedback based on periodic audits is desirable. Pre-and posthabilitation are emerging concepts that are becoming relevant for the implementation of these protocols.

Implementation of the ERAS program in gastric surgery: a nationwide survey in Italy

“…However, other studies have reported how, despite the demonstrated advantages of the applications of ERAS protocol for gastrectomy, their actual applications in daily practice is lower than expected [ 18 , 19 ]. It is interesting to note that most studies in the literature on the efficacy of a structured ERAS protocol in gastric resective surgery come from the East [ 20 ].…”