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Enhanced Recovery for Esophagectomy: A Systematic Review and Evidence-Based Guidelines

Findlay, John M. BMedSci, BMBS (Hons), MRCS*; Gillies, Richard S. MD, FRCS*; Millo, Julian BSc, MRCP, FRCA, DICM, FFICM; Sgromo, Bruno MD*; Marshall, Robert E. K. MS, FRCS*; Maynard, Nicholas D. MS, FRCS*

Annals of Surgery:
doi: 10.1097/SLA.0000000000000349
Review
Abstract

Objective: This article aims to provide the first systematic review of enhanced recovery after surgery (ERAS) programs for esophagectomy and generate guidelines.

Background: ERAS programs use multimodal approaches to reduce complications and accelerate recovery. Although ERAS is well established in colorectal surgery, experience after esophagectomy has been minimal. However, esophagectomy remains an extremely high-risk operation, commonly performed in patients with significant comorbidities. Consequently, ERAS may have a significant role to play in improving outcomes. No guidelines or reviews have been published in esophagectomy.

Methods: We undertook a systematic review of the PubMed, EMBASE, and the Cochrane databases in July 2012. The literature was searched for descriptions of ERAS in esophagectomy. Components of successful ERAS programs were determined, and when not directly available for esophagectomy, extrapolation from related evidence was made. Graded recommendations for each component were then generated.

Results: Six retrospective studies have assessed ERAS for esophagectomy, demonstrating favorable morbidity, mortality, and length of stay. Methodological quality is, however, low. Overall, there is little direct evidence for components of ERAS, with much derived from nonesophageal thoracoabdominal surgery.

Conclusions: 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.

In Brief

Enhanced recovery after surgery (ERAS) programs have significantly improved outcome after certain operations, but experience after esophagectomy has been minimal. This article provides the first systematic review and guidelines of ERAS programs and their components for esophagectomy.

Author Information

*Oxford OesophagoGastric Centre, Churchill Hospital; and

Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, United Kingdom.

Reprints: John M. Findlay, BMedSci, BMBS (Hons), MRCS, Oxford OesophagoGastric Centre, Churchill Hospital, Oxford OX3 7LJ, United Kingdom. E-mail: johnfindlay@doctors.org.uk.

Disclosure: The authors declare no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins.