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INTRODUCTION: With the increasing use of minimally invasive esophagectomy (MIE) and early hospital discharge, the timing and role of postoperative contrast swallow study (SS) has become increasingly problematic. We systematically evaluated a policy of delayed SS and oral intake after MIE until the second postoperative week, approximately one week after hospital discharge.
METHODS: Between Sept 2007 and October 2012, 143 consecutive patients undergoing MIE were evaluated for inclusion in the study. Patients with obvious clinical or radiographic leak by d 7 were excluded from the study. Our study group consisted of 30 patients (Late Eaters) whose SS and po intake were intentionally delayed (20 patients) until a week after hospital discharge or were delayed by postop events (10 patients) which made early SS and institution or oral feeds impractical. The study group was compared to a control group who were deemed ready to have SS done and po intake started while in the hospital on postop day 5-7. Primary endpoints studied were the anastomotic leak rate (ALR) and the hospital length of stay (LOS).
RESULTS: Data are shown in Table 1.
CONCLUSION: After MIE, a policy of early hospital discharge nil per os, delaying SS and resumption of oral intake to about two weeks postoperatively, significantly reduces hospital LOS and anastomotic leak rate. Early institution or oral feeds after MIE appears to increase ALR.
Table 1

	Postop Day on which SS done and oral intake begun (median)	Anastomotic Leak Rate	Hospital Length of Stay
Early Eaters (n=91)	D6	22% (20/91)	D8
Late Eaters (n=30)	D12	3% (1/30)	D6
	p < 0.05	p < 0.05	p < 0.05