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Christopher Hadjittofi*, Pedro Serralheiro, Bhaskar Kumar, Hugh Warren, Edward Cheong, Michael Lewis
Esophagogastric Cancer Center, Norfolk & Norwich University Hospital, Norwich, United Kingdom

Introduction: Enhanced Recovery After Surgery (ERAS) is a multimodal evidence-based approach, which aims to optimize patients and standardize perioperative care, thereby improving postoperative outcomes and recovery. In addition to achieving superior clinical outcomes and patient experience, ERAS reduces institutional costs. The aim of this study was to investigate the impact of ERAS on morbidity, mortality, length of hospital stay, and readmission following esophageal and gastric cancer surgery.

Methods: A prospectively maintained database from a high-volume tertiary esophagogastric centre, specializing in minimally invasive esophagectomy (MIE), was interrogated to determine whether postoperative outcomes before and after the introduction of an ERAS program were significantly different. The local ERAS program was established in 2014. Major esophagogastric resection cases were divided into three-year groups as either "pre-ERAS" (2011-2013) or "post-ERAS" (2014-2016).

Results: Between 2011 and 2016 inclusive, 287 patients (pre-ERAS n=186; post-ERAS n=101) underwent esophagogastric surgery (esophagectomy n=196; gastrectomy n=91) for cancer. Esophagectomy was predominantly MIE, and gastrectomy by open approach. The male-to-female ratio was 3:1 and the mean age was 68 years (standard deviation = 9.51). The overall anastomotic leak rate was 12.5%, with no significant difference between the pre-ERAS and post-ERAS groups (12.4% vs. 12.9%; p=0.902). The overall severe (Clavien-Dindo ‚Č•IIIb) complication rate was 13.6% with no significant difference between groups (14.0% vs. 12.9%; p=0.794). The overall inpatient mortality rate was 1.4% with no significant difference between groups (1.6% vs. 1.0%; p=0.668). The overall 30-day mortality rate was 1.0% with no significant difference between groups (1.1% vs. 0; p=0.297). Length of hospital stay improved from a median of 10 days (range: 2-109) to a median of 7 days (range: 4-152) with the ERAS protocol (p=0.001). The readmission rates were 15.3% and 14.7% respectively, with no significant difference (p=0.963).

Conclusion: Implementation of an ERAS program for esophagogastric cancer surgery is associated with a significant reduction in length of hospital stay, with no compromise on morbidity, mortality or readmission rates.

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