Surgical resection remains as the only curative option for oesophagogastric cancers but carries a significant morbidity and mortality. Enhanced Recovery After Surgery (ERAS) protocols adopted by many high volume resectional centres across the world have demonstrated reductions in peri-operative complications and length of stay. To date however, there has been a paucity of literature in the application of ERAS in an Australian setting and its impact on peri-operative outcomes.
An ERAS protocol was developed at Alfred Hospital for oesophageal cancer resections and has been routinely used for patients since July 2017. Patient demographics and peri-operative data was collected and recorded in a local cancer database and compared to resections prior to July 2017.
A total of 135 patients underwent oesophagectomy between July 2014 and July 2019, 86 patients in the control group (Pre-ERAS), and 49 in the interventional group. The length of stay for patients without complication reduced by 2.5 days (14.5 days vs. 12 days, p = 0.013) after implementation of the ERAS protocol. The number of patients requiring blood transfusions reduced (32.9% vs. 12.5%, p = 0.01). All respiratory complications reduced in the ERAS patient group (41.9% vs. 36.7%, p = 0.559). The rate of clinically apparent atelectasis (14% vs. 4.1%, p = 0.07) and respiratory failure (defined as those requiring supplemental oxygen therapy, 41.9% vs. 34.7%, p = 0.412) reduced. There was no adverse change in the anastomotic leak rate after the implementation of ERAS (10.5% vs., 10.2%, p = 0.962) and no increase in the overall complication rate.
The use of an ERAS protocol in patients undergoing oesophagogastric resections in a comparatively high volume resectional centre in Australia, results in significant reduction in postoperative complications and inpatient length of stay, in keeping with previously published international published data.