The implementation and effectiveness of an enhanced recovery programme after oesophago-gastrectomy: A prospective cohort study

Ford, Samuel J.; Adams, David B.; Dudnikov, S.; Peyser, P; Rahamim, J; Wheatley, Tim; Berrisford, Richard; Sanders, Grant

doi:10.1016/j.ijsu.2014.01.015

Cited by 44 publications

(28 citation statements)

References 16 publications

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“…There were 11 articles (1,128 patients) on fast track oesophageal surgery [11][12][13][14][15][16][17][18][19][20][21] and 7 (329 patients) on fast track gastric surgery. 12,[22][23][24][25][26][27] Ten articles were case series, five were case-controlled studies and three were RCTs (all gastrectomy related with a Jadad score of 1 or 2).…”

Section: Resultsmentioning

confidence: 99%

Systematic review of enhanced recovery after gastro-oesophageal cancer surgery

Gemmill

Humes

Catton

2015

annals

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INTRODUCTION Fast track methodology or enhanced recovery schemes have gained increasing popularity in perioperative care. While evidence is strong for colorectal surgery, its importance in gastric and oesophageal surgery has yet to be established. This article reviews the evidence of enhanced recovery schemes on outcome for this type of surgery. METHODS A systematic literature search was conducted up to March 2014. Studies were retrieved and analysed using predetermined criteria. RESULTS From 34 articles reviewed, 18 eligible studies were identified: 7 on gastric and 11 on oesophageal resection. Three randomised controlled trials, five case-controlled studies and ten case series were identified. The reported protocols included changes to each stage of the patient journey from pre to postoperative care. The specific focus following oesophageal resections was on early mobilisation, a reduction in intensive care unit stay, early drain removal and early (or no) contrast swallow studies. Following gastric resections, the emphasis was on reducing epidural anaesthesia along with re-establishing oral intake in the first three postoperative days and early removal of nasogastric tubes. In the papers reviewed, mortality rates following fast track surgery were 0.8% (9/1,075) for oesophageal resection and 0% (0/329) for gastric resection. The reported morbidity rate was 16.5% (54/329) following gastric resection and 38.6% (396/1,075) following oesophageal resection. Length of stay was reduced in both groups compared with conventional recovery groups in comparative studies. CONCLUSIONS The evidence for enhanced recovery schemes following gastric and oesophageal resection is weak, with only three (low volume) published randomised controlled trials. However, the enhanced recovery approach appears safe and may be associated with a reduction in length of stay.

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Section: Resultsmentioning

confidence: 99%

Systematic review of enhanced recovery after gastro-oesophageal cancer surgery

Gemmill

Humes

Catton

2015

annals

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“…In the years following surgery, patients often experience problems affecting nutritional status, such as diarrhea, appetite loss, nausea, and vomiting [11]. Improvement in outcome may be achieved by appropriate risk assessment [6,12,13], pre-optimization [14], use of multimodality treatment [3], centralization of esophageal cancer surgery [15], use of minimally invasive esophagectomy techniques [16,17], and an enhanced recovery in esophagectomy pathway [16,[18][19][20][21][22][23][24][25][26]. In many of these new developments, nutrition has an essential role.…”

Section: Introductionmentioning

confidence: 99%

Nutrition in peri-operative esophageal cancer management

Steenhagen

Vulpen

Hillegersberg

et al. 2017

Expert Review of Gastroenterology & Hepatology

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Introduction: Nutritional status and dietary intake are increasingly recognized as essential areas in esophageal cancer management. Nutritional management of esophageal cancer is a continuously evolving field and comprises an interesting area for scientific research. Areas covered: This review encompasses the current literature on nutrition in the pre-operative, perioperative, and post-operative phases of esophageal cancer. Both established interventions and potential novel targets for nutritional management are discussed. Expert commentary: To ensure an optimal pre-operative status and to reduce peri-operative complications, it is key to assess nutritional status in all pre-operative esophageal cancer patients and to apply nutritional interventions accordingly. Since esophagectomy results in a permanent anatomical change, a special focus on nutritional strategies is needed in the post-operative phase, including early initiation of enteral feeding, nutritional interventions for post-operative complications, and attention to longterm nutritional intake and status. Nutritional aspects of pre-optimization and peri-operative management should be incorporated in novel Enhanced Recovery After Surgery programs for esophageal cancer.ARTICLE HISTORY

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“…Guideline recommendations for perioperative care in colon and rectal surgery have been published and cover multiple pre-, intra-, and postoperative ERAS elements (e.g., preoperative fasting and bowel preparation or antimicrobial prophylaxis, intraoperative analgesia and fluid management, postoperative pain and drainage management, nutritional care, mobilization) [4][5][6]. Following the example of colorectal surgery, ERAS programs have been adapted for major visceral surgery like hepato-pancreatobiliary (HPB) or gastric surgery during recent years [7][8][9][10][11]. All such programs report a significant reduction of postoperative hospital stay with reduced or equal morbidity rates compared with standard treatment pathways.…”

Section: Introductionmentioning

confidence: 99%