The effect of enhanced recovery after minimally invasive esophagectomy: a randomized controlled trial

Abstract

Background The purpose of this randomized controlled trial was to determine if enhanced recovery after surgery (ERAS) would improve outcomes for three-stage minimally invasive esophagectomy (MIE). Methods Patients with esophageal cancer undergoing MIE between March 2016 and August 2018 were consecutively enrolled, and were randomly divided into 2 groups: ERAS+group that received a guideline-based ERAS protocol, and ERAS- group that received standard care. The primary endpoint was morbidity after MIE. The secondary endpoints were the length of stay (LOS) and time to ambulation after the surgery. The perioperative results including the Surgical Apgar Score (SAS) and Visualized Analgesia Score (VAS) were also collected and compared. Results A total of 60 patients in the ERAS+ group and 58 patients in the ERAS- group were included. Postoperatively, lower morbidity and pulmonary complication rate were recorded in the ERAS+ group (33.3% vs. 51.7%; p = 0.04, 16.7% vs. 32.8%; p = 0.04), while the incidence of anastomotic leakage remained comparable (11.7% vs. 15.5%; p = 0.54). There was an earlier ambulation (3 [2–3] days vs. 3 [3–4] days, p = 0.001), but comparable LOS (10 [9–11.25] days vs. 10 [9–13] days; p = 0.165) recorded in ERAS+ group. The ERAS protocol led to close scores in both SAS (7.80 ± 1.03 vs. 8.07 ± 0.89, p = 0.21) and VAS (1.74 ± 0.85 vs. 1.78 ± 1.06, p = 0.84). Conclusions Implementation of an ERAS protocol for patients undergoing MIE resulted in earlier ambulation and lower pulmonary complications, without a change in anastomotic leakage or length of hospital stay. Further studies on minimizing leakage should be addressed in ERAS for MIE.

An esophagectomy surgical Apgar score-based nomogram—a risk-based postoperative triage system: a phase II randomised trial

“…Unexpectedly, we did not find a significant difference in the incidence of anastomotic leakage between the two groups (P=0.12). During the period of this study, the probability of developing anastomotic leakage in our center was 5.9%, which is lower than that reported elsewhere ( 5 , 11 , 26 ). This could be attributed to differences in prehospitalization and preoperative surgery screening and surgical technique.…”

The Evolution of Enhanced Recovery After Surgery

“…Reduced pain also encourages patients to engage in early ambulation and respiratory exercises, promoting faster recovery and minimizing the risk of pulmonary complications. 22 ERAS emphasizes the importance of early mobilization, encouraging patients to ambulate and engage in physical therapy as soon as possible after surgery. In the context of spine surgery, this may include exercises that strengthen the muscles involved in swallowing and breathing, as well as interventions to improve overall physical fitness and nutritional status.…”

“…Effective pain control reduces the discomfort associated with surgery, allowing patients to move and perform swallowing exercises more comfortably postoperatively. Reduced pain also encourages patients to engage in early ambulation and respiratory exercises, promoting faster recovery and minimizing the risk of pulmonary complications 22 . ERAS emphasizes the importance of early mobilization, encouraging patients to ambulate and engage in physical therapy as soon as possible after surgery.…”

Esophagectomy with immediate reconstruction under fast track program

“…[18], продемонстрировавшие низкую частоту осложнений (8,6 и 10,5% соответственно), включили в исследования только соматически здоровых пациентов (ASA I-II). Большинство авторов, опубликовавших данные по ERAS при ЭЭ, выполняли мини-инвазивные вмешательства [19] или операции Льюиса [20], имели критерии включения и исключения из исследования [21] и не представили детальный разбор структуры осложнений [22]. Кроме того, до 2015 г. отсутствовал единый реестр осложнений после ЭЭ, и позднее, когда реестр был создан, не все исследователи использовали его в своих отчетах.…”