Abstract
<i>Background</i>: This study aims to examine if a standardized enhanced recovery program (ERP) could reduce the length of stay (LOS) after minimally invasive esophagectomy (MIO) compared to the earlier applied recovery program without increasing the risk of postoperative complications and readmissions. <i>Methods</i>: Retrospective study of patients with esophageal and gastroesophageal junction cancer who have had an uncomplicated postoperative stay following MIO. Patients had followed two different postoperative recovery programs according to their year of surgery (2016 versus 2018). <i>Results</i>: 48 patients in 2016 and 42 patients in 2018 were included. Patients were comparable on demographic factors. The median LOS was reduced from 9 days in 2016 to 8 days in 2018 (p<0.001). In 2018, 27 patients (64.3%) fulfilled the aim of discharge to their own home on day 8 after surgery. There was no significant difference (p>0.05) between the two groups in the risk of complications (Clavien-Dindo degree 0-2). Two patients in 2016 (4.2%) and two patients in 2018 (4.8%) were readmitted within 7 days after discharge (not significant). There was no in-hospital mortality or 30-day mortality in either of the two groups. <i>Conclusion</i>: The introduction of an ERP at our institution reduced the median postoperative stay after MIO by one day without increasing the risk of complications and readmittance. Further reduction might be obtained if oral feeding is allowed earlier.
Highlights
Curative treatment of cancer in the esophagus or at the gastroesophageal junction (GEJ) consists of surgery often combined with perioperative oncological treatment
Large incisions are avoided by minimally invasive esophagectomy (MIO) and, in addition, the technique has been associated with reduced risk of cardio-pulmonary complications, less intraoperative blood loss and shorter length of stay (LOS) [1]
Guidelines on enhanced recovery program (ERP) after colorectal surgery, liver surgery and gastrectomy have existed for some years [6,7,8], and guidelines on ERP following esophagectomy have recently been published but these are primarily based on experience from the open era [9]
Summary
Curative treatment of cancer in the esophagus or at the gastroesophageal junction (GEJ) consists of surgery often combined with perioperative oncological treatment. At first the department’s postoperative recovery program was the same as the one in the open era, but after getting familiar with the new surgical technique we started to apply a standardized postoperative enhanced recovery program (ERP) on the patients. This study aims to examine if a standardized enhanced recovery program (ERP) could reduce the length of stay (LOS) after minimally invasive esophagectomy (MIO) compared to the earlier applied recovery program without increasing the risk of postoperative complications and readmissions. Methods: Retrospective study of patients with esophageal and gastroesophageal junction cancer who have had an uncomplicated postoperative stay following MIO. Conclusion: The introduction of an ERP at our institution reduced the median postoperative stay after MIO by one day without increasing the risk of complications and readmittance. Further reduction might be obtained if oral feeding is allowed earlier
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