272. IMPLEMENTATION OF AN ERAS PROTOCOL IN PATIENTS UNDERGOING ESOPHAGECTOMY: EVALUATION OF THE RESULTS

Abstract

Abstract Esophagectomy is a complex surgery and has classically been a surgery with high morbidity and mortality and high hospital stay. The implementation of ERAS protocols in esophageal surgery is lagging behind other digestive surgeries due to its complexity, but little by little ERAS protocols are starting to be implemented in high volume units. Retrospective and descriptive analysis of 50 patients undergoing elective McKeown esophagectomy (April 2018–December 2021). The ERAS protocol starts with prehabilitation. Unless contraindicated, they receive an epidural catheter and a minimally invasive approach; no abdominal or cervical drains, decompressive nasogastric tube or feeding jejunostomy are left in place unless risk of malnutrition. From the first postoperative day they begin to sit up and start respiratory and motor rehabilitation; after leaving the ICU, they begin to deambulate and the bladder catheter is removed. The descriptive study used median and interquartile range (IQR) for quantitative variables and percentage of cases for qualitative variables. A total of 50 patients were analysed. The 70% were men, median age was 64,50 years (55,75–71), BMI 23.20 (20,9-26,3). The 20% were diabetic, 28% were bronchopathic and 14% had some type of heart disease. The 54% had an ASA ≥3. The etiology was neoplasic in 90% and 10% due to stenosis after caustic ingestion; 79,7% received neoadjuvant treatment. Feeding jejunostomy was performed in 42%, abdominal drainage was placed in 18% and thoracic drainage in 50%. The epidural catheter was removed on the 3rd day (2,25-5,75). Table 1 shows the postoperative results. The implementation of an ERAS protocol in esophageal surgery is necessary and feasible with good results, without an increase in morbimortality and with a decrease in hospital stay and an improvement in patient comfort.