The enhanced recovery after surgery (ERAS) protocol to promote recovery following esophageal cancer resection

Abstract

Esophageal cancer surgery, comprising esophagectomy with radical lymphadenectomy, is a complex procedure associated with considerable morbidity and mortality. The enhanced recovery after surgery (ERAS) protocol which aims to improve perioperative care, minimize complications, and accelerate recovery is showing promise for achieving better perioperative outcomes. ERAS is a multimodal approach that has been reported to shorten the length of hospital stay, reduce surgical stress response, decrease morbidity, and expedite recovery. While ERAS components straddle preoperative, intraoperative, and postoperative periods, they need to be seen in continuum and not as isolated elements. In this review, we elaborate on the components of an ERAS protocol after esophagectomy including preoperative nutrition, prehabilitation, counselling, smoking and alcohol cessation, cardiopulmonary evaluation, surgical technique, anaesthetic management, intra-and postoperative fluid management and pain relief, mobilization and physiotherapy, enteral and oral feeding, removal of drains, and several other components. We also share our own institutional protocol for ERAS following esophageal resections.

Feasibility of enhanced recovery protocol in minimally invasive McKeown esophagectomy

“…Most patients in this study required cervical lymphadenectomy due to oncological background. Overall complications and anastomotic leakage between the two groups were similar to previous outcomes, which support postoperative early recovery [15,16].…”

“…Implementation of the ERAS protocol after esophagectomy was successful with respect to complications, postoperative hospital stay, and costs [8,[11][12][13][14][15][16][17][18][19][20][21][22]25]. In addition, postoperative EN after thoracoscopic esophagectomy was more favorable than total parental nutrition for bodyweight loss (-2.94 ± 3.19% vs. 5.05 ± 3.65%, P = 0.020) [26].…”

Patient-Related Prognostic Factors for Anastomotic Leakage, Major Complications, and Short-Term Mortality Following Esophagectomy for Cancer: A Systematic Review and Meta-Analyses

“…6,7 The implementation of Enhanced Recovery After Surgery (ERAS) protocols reduces postoperative complication rates. 8 Further reduction of major complications may be achieved by tailormade perioperative care using personalized prehabilitation programs. In addition, benchmarking surgical outcomes in national clinical audits might lead to a further decrease of surgical morbidity.…”

New Trends in Esophageal Cancer Management

“…The enhanced recovery after surgery (ERAS) program in esophageal surgery is a multimodal approach that has been shown to reduce hospital stay, surgical stress and postoperative morbidity. It includes preoperative nutrition, prehabilitation, cardiorespiratory assessment, surgical and anesthetic technique, pain management, physical therapy, and early drain removal [ 14 ]. However, the concept of minimally invasive surgery is vast and is increasingly being adopted around the world [ 15 ].…”