ERAS protocol after minimally invasive esophagectomy lowers complications risk
China: For patients undergoing minimally invasive esophagectomy (MIE), implementation of an enhanced recovery after surgery (ERAS) protocol results in lower pulmonary complications and earlier ambulation, says a recent study published in Surgical Endoscopy. However, there was no change in length of hospital stay or anastomotic leakage.
The randomized controlled trial was conducted by Hao Wang, Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China, and colleagues with the purpose to determine if ERAS would improve outcomes for three-stage minimally invasive esophagectomy.
For this purpose, the researchers consecutively enrolled patients with esophageal cancer undergoing MIE between March 2016 and August 2018. They were randomly divided into two groups: ERAS+group (n=60) that received a guideline-based ERAS protocol, and ERAS- group (n=58) that received standard care.
Morbidity after MIE was the primary endpoint. The secondary endpints included length of stay (LOS) and time to ambulation after the surgery. Collection and comparison were done of the perioperative results including the Surgical Apgar Score (SAS) and Visualized Analgesia Score (VAS).
The study led to the following findings:
- Postoperatively, lower morbidity and pulmonary complication rate were recorded in the ERAS+ group (33.3% vs. 51.7%, 16.7% vs. 32.8%), while the incidence of anastomotic leakage remained comparable (11.7% vs. 15.5%).
- There was earlier ambulation (3 days vs. 3 days), but comparable LOS (10 days vs. 10 days) was recorded in the ERAS+ group.
- The ERAS protocol led to close scores in both SAS (7.80 ± 1.03 vs. 8.07 ± 0.89) and VAS (1.74 ± 0.85 vs. 1.78 ± 1.06).
The authors concluded by saying that, "implementation of an ERAS protocol for patients undergoing MIE resulted in a lower incidence of pulmonary complications and earlier ambulation, without a change in overall length of hospital stay."
"Further studies on minimizing leakage should be addressed in ERAS for MIE," they wrote.
Reference:
Shen, Y., Chen, X., Hou, J. et al. The effect of enhanced recovery after minimally invasive esophagectomy: a randomized controlled trial. Surg Endosc (2022). https://doi.org/10.1007/s00464-022-09385-6
