Enhanced Recovery for Esophagectomy

Findlay, John M.; Gillies, Robert J.; Millo, Julian; Sgromo, Bruno; Marshall, Robert; Maynard, Nicholas

doi:10.1097/sla.0000000000000349

Cited by 219 publications

(78 citation statements)

References 164 publications

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“…Esophageal cancer has always been associated with a poor survival, but over the past decades the survival rate for patients undergoing surgery has significantly improved with the introduction of neoadjuvant chemoradiotherapy [1][2][3]. Improved perioperative care, the implementation of enhanced recovery programs and the introduction of minimally invasive techniques, have further contributed to a reduced postoperative mortality and morbidity [4][5][6][7][8]. With these improvements and an increase in survival rates, patients' quality of life and long-term sequelae-such as development of micronutrient deficiencies-of this intensive treatment are becoming more relevant [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Micronutrient Deficiencies Following Minimally Invasive Esophagectomy for Cancer

et al. 2020

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Over the past decades, survival rates for patients with resectable esophageal cancer have improved significantly. Consequently, the sequelae of having a gastric conduit, such as development of micronutrient deficiencies, become increasingly apparent. This study investigated postoperative micronutrient trends in the follow-up of patients following a minimally invasive esophagectomy (MIE) for cancer. Patients were included if they had at least one postoperative evaluation of iron, ferritin, vitamins B1, B6, B12, D, folate or methylmalonic acid. Data were available in 83 of 95 patients. Of these, 78.3% (65/83) had at least one and 37.3% (31/83) had more than one micronutrient deficiency at a median of 6.1 months (interquartile range (IQR) 5.4-7.5) of follow-up. Similar to the results found in previous studies, most common deficiencies identified were: iron, vitamin B12 and vitamin D. In addition, folate deficiency and anemia were detected in a substantial amount of patients in this cohort. At 24.8 months (IQR 19.4-33.1) of follow-up, micronutrient deficiencies were still common, however, most deficiencies normalized following supplementation on indication. In conclusion, patients undergoing a MIE are at risk of developing micronutrient deficiencies as early as 6 up to 24 months after surgery and should therefore be routinely checked and supplemented when needed.

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Section: Introductionmentioning

confidence: 99%

Micronutrient Deficiencies Following Minimally Invasive Esophagectomy for Cancer

et al. 2020

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“…The evidence for ERAS in oesophageal surgery is poor; in a recent systematic review, Findlay et al identified only eight retrospective series with a total of 1127 patients. These were predominantly reports of single surgeon series and open resections 4. In some units, one surgeon but not others have embraced ERAS for oesophageal surgery5, and in other units, only the fittest patients have been included, making the overall benefits hard to establish 6…”

Section: Introductionmentioning

confidence: 99%

The Development, Application and Analysis of an Enhanced Recovery Programme for Major Oesophagogastric Resection

Underwood

Noble

Madhusudan

et al. 2017

Journal of Gastrointestinal Surgery

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BackgroundEnhanced recovery programmes improve outcomes in surgery, but their implementation after upper gastrointestinal resection has been limited. The aim of this study was to compare short-term outcomes for patients undergoing oesophagogastric surgery in an enhanced recovery programme (EROS).MethodsEROS was developed after a multidisciplinary meeting by multiple rounds of revision. EROS was applied to all patients undergoing major upper GI resection at a university teaching hospital in the UK from 20/9/13, with data reviewed at 18/09/15. EROS was assessed to identify predictors for compliance.ResultsOne hundred six patients underwent major upper GI resection including 81 oesophagectomies, 24 gastrectomies and 1 colonic interposition graft. Major complications (Clavien Dindo ≥3) occurred in 12 patients with 1 in-hospital death. Thirty-five patients (44%) were discharged on target day 8 of the EROS programme. Age and complications were independently associated with missing this discharge target.ConclusionEnhanced recovery is feasible and safe after major upper gastrointestinal surgery.Electronic supplementary materialThe online version of this article (doi:10.1007/s11605-017-3363-8) contains supplementary material, which is available to authorized users.

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“…Suboptimal pain management is a recognized risk factor for respiratory complications after transthoracic esophagectomy 1. Thoracic epidural analgesia (TEA) is the current gold-standard analgesia in these patients and is an important component of the fast-track programs 2–4. However, TEA cannot always be performed and other strategies of pain relief need to be considered in select patients.…”

Section: Introductionmentioning

confidence: 99%

Serratus anterior plane block for hybrid transthoracic esophagectomy: a pilot study

Barbera¹,

Milito²,

Punturieri³

et al. 2017

JPR

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BackgroundPain is a major limiting factor in patient’s recovery from major thoracic surgical procedures. Thoracic epidural analgesia (TEA), the current gold standard of perioperative management, has contraindications, can technically fail, and carries a risk of complications such as epidural abscess and spinal hematoma. The ultrasound-guided serratus anterior plane (SAP) block is a promising regional analgesia technique.ObjectivesSince the anatomic space involved in the SAP block corresponds to the area exposed by the surgeon during right posterolateral thoracotomy, we investigated the feasibility of a “surgically guided” continuous SAP block as an alternative to TEA in selected esophagectomy patients.Study designThis was a pilot case-series study.SettingThis study was carried out in a tertiary-care university hospital.MethodsThe demographic and clinical data of patients in whom the continuous SAP block was performed were retrieved from a prospectively maintained database of hybrid (laparoscopy plus right thoracotomy) Ivor Lewis esophagectomy. The SAP block was performed upon closure of the thoracotomy incision using a 19-gauge catheter tunnelized subcutaneously and positioned in the deep plane between the serratus anterior muscle and the ribs. A bolus dose of 30 mL of levobupivacaine 0.25% was injected, followed by a continuous infusion of the 0.125% solution at 7 mL/h until postoperative day 4.ResultsBetween January 2016 and July 2016, seven (20%) out of 37 esophagectomy patients underwent a SAP block rather than TEA for the following reasons: inability to insert the epidural catheter, antiaggregation or anticoagulant therapy, or unplanned thoracotomy. The procedure was uneventful in all patients. Only two patients required rescue analgesia on day 1.ConclusionContinuous SAP block under direct vision is feasible and safe. This novel “surgically guided” application of the SAP block may be useful in case of failure or contraindications to TEA.

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Enhanced Recovery for Esophagectomy

Abstract: ERAS in principle seems logical and safe for esophagectomy. However, the underlying evidence is poor and lacking. Despite this, a number of recommendations for practice and research can be made.

Cited by 219 publications

References 164 publications

Micronutrient Deficiencies Following Minimally Invasive Esophagectomy for Cancer

Micronutrient Deficiencies Following Minimally Invasive Esophagectomy for Cancer

The Development, Application and Analysis of an Enhanced Recovery Programme for Major Oesophagogastric Resection

Serratus anterior plane block for hybrid transthoracic esophagectomy: a pilot study

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