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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. Therefore we investigated the feasibility and possible benefit of a perioperative enhanced recovery program in patients undergoing esophagectomy for malignant disease.
Methods
From January 2009 until March 2010 all esophageal cancer patients undergoing surgical resection who were treated according to the ERAS were included in this study. ERAS items included preoperative counselling, preoperative nutrition, early removal of nasogastric tube and early mobilization. Primary outcome parameters were overall hospital stay and the incidence of postoperative complications. Outcome measures in the ERAS cohort were compared to a cohort of patients who underwent surgical resection in the three years prior to implementation of the ERAS protocol.
Results
A total of 89 esophageal cancer patients underwent surgical resection between January 2009 and March 2010. 72 patients were included in the ERAS protocol (ERAS + group) and compared to 296 patients who underwent an esophagectomy between 2005 and 2008 (ERAS - group). Patient characteristics were comparable with the exception of a history of cardiovascular disease and the number of patients who underwent neoadjuvant therapy (50% in ERAS + versus 36% in ERAS -, p=0.03 and 60% in ERAS + versus 22% in ERAS -, p<0.001 respectively). Overall hospital stay was 14 days in ERAS + versus 15 days in ERAS - (p0.04). There were no significant differences in the incidence of postoperative complications in both groups.
Conclusion
The implementation of an ERAS program in esophageal surgery resulted in a small but significant reduction of overall hospital stay, whereas overall morbidity was not affected.