Authors (including presenting author) :
Lam CT, Kong FY, So CK, Leung KW, Chow TL
Affiliation :
Division of upper GI and metabolic sugery, Department of Surgery, United Christian Hospital
Introduction :
Enhanced recovery after surgery (ERAS) has been implemented in different field of gastrointestinal surgery but the adoption in esophagectomy is not widespread. We reviewed the feasibility and safety of ERAS program in patient undergoing esophagectomy.
Objectives :
To review the early clinical outcome of patient undergoing minimal invasive esophagectomy (MIE) under ERAS pathway
Methodology :
ERAS program for esophagectomy was initiated in 2017. We compared patient underwent MIE with ERAS pathway during 2017-2018 to a similar cohort during 2015-2016. Patient in ERAS group adopt early resumption of enteral feeding, early removal of naso-gastric tube, drains and early mobilization. The primary outcome is hospital stay. The secondary outcomes include post-operative complications, time to resume feeding, time to removal of tubes and drains.
Result & Outcome :
43 patients underwent MIE between 2015 and 2018. 24 patients were in the ERAS group and 19 patients in non-ERAS group. The baseline characteristics were similar. There were no statistically significant difference in operative time, blood loss, transfusion rate and conversion rate. There were significant less abdominal drain and left side chest drain placed in ERAS group. The median hospital study was significantly shorter in ERAS group (10 days versus 23 days, p=0.001). The time to resume clear fluid diet (3day versus 8.5 days, p=0.05), fluid diet (4 days versus 9 days, p=0.004) and puree diet (5 days versus 10.5 days, p=0.004) was also significant earlier in ERAS group. The time to initiate enteral tube feeding was earlier in ERAS group (day 1 versus day 6, p< 0.05) and the duration of supplementary tube feeding was also shorter in ERAS group (6 days versus 9 days, p< 0.05). There was significant less usage of parental nutrition in ERAS group (0 day versus 9 days, p< 0.05). The removal of nasogastric tube (7 days versus 14 days, p=0.015), Foley catheter (6 days versus 8 days p=0.027), central venous catheter (4 days versus 10.5 days, p< 0.05), PCEA catheter (5 days versus 6 days, p=0.011) were also significantly earlier in ERAS group. There was no significant difference of morbidity and post-operative complications between two groups (p=0.631).
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