F-049OUTCOMES OF MODIFIED ENHANCED RECOVERY AFTER SURGERY PROTOCOLS FOR THE PATIENTS UNDERGOING MINIMALLY INVASIVE OESOPHAGECTOMY

Abstract

Objectives: Esophagectomies are accompanied with a high rate of postoperative complications. However, rare studies regarded the differences between the outcomes of enhanced recovery after surgery and standard care in minimally invasive oesophagectomy. In recent years, we have modified our ERAS protocols. We conducted this study to compare outcomes of modified ERAS (mERAS) and conventional standard care (SC). Methods: The mERAS was implemented from 1st November 2015. In mERAS group, we did accurate nutrition evaluation, did the additional oral care, modified the procedures of the anatomosis, used normothermia system, used pneumatic compression stockings and intraoperatively placed patient controlled intravenous analgesia. In both groups, we did the skeletonization of recurrent laryngeal nerves, using oesophageal suspension method. In mERAS group, if it was possible, we used low-molecular-dextran and low-molecular-weight heparin after the operation, and postponed the fasting time. Results: This study included 254 patients (142 in mERAS group, 112 in SC group). There was no significant difference in characteristics. In mERAS group, 96.4% of the patients had completed the mERAS items, patients passed flatus and a stool 2 days earlier (P=0.041) and median length of hospital stay was significantly shorter (P=0.039). Surprisingly, incidence rate of anastomotic leakage was significantly lower (0.0% vs 8.9%, P=0.000), as well as overall morbidity. There was no significant difference in incidence rates of vocal cord paresis and pulmonary infection, both of which were lower than the rates of reported studies. Conclusions: To the best of our knowledge, this is the largest reported series of ERAS protocols in patients undergoing oesophagectomy. According to our study, the implementation of mERAS protocols in patients undergoing minimally invasive esopahgectomy was feasible and safe, and could result in better functional recovery and reduction in overall morbidity and length of hospital stay.