Enhanced Recovery after Surgery Protocols in Esophagectomy for Cancer

Abstract

Introduction: Esophagectomy carries high morbidity. Enhanced recovery after surgery (ERAS) protocols have been applied to reduce complications and shorten hospital stay. This review evaluates the evidence for ERAS in esophageal cancer surgery.

Methods: A literature search was performed for studies comparing ERAS versus conventional care in esophagectomy. Outcomes were postoperative pulmonary complications, anastomotic leak, hospital stay, and readmission rates. Specific elements (prehabilitation, epidural analgesia, early feeding) were examined.

Results: Fourteen studies (one randomized trial) were included. ERAS reduced hospital stay by three to five days without increasing readmission rates. Pulmonary complications were reduced by about one-third, likely due to early mobilization and aggressive respiratory care. Anastomotic leak rates were unchanged. Compliance with ERAS elements varied widely; high compliance was associated with better outcomes.

Discussion: Esophagectomy ERAS protocols differ from colorectal ERAS due to the high risk of aspiration and need for meticulous nutrition support. Early oral feeding is safe after esophagogastric anastomosis. Prehabilitation (nutritional and exercise) appears promising but is understudied. Thoracic epidural analgesia remains the gold standard.

Conclusions: ERAS protocols improve outcomes after esophagectomy, particularly reducing pulmonary complications and hospital stay. Standardization and audit of compliance are essential for success.