326. LONG-TERM OUTCOMES OF MODIFIED ENHANCED RECOVERY AFTER SURGERY (MERAS) PROTOCOLS IN PERI-OPERATIVE MANAGEMENT OF MINIMALLY INVASIVE ESOPHAGECTOMY

Abstract

Enhanced recovery after surgery (ERAS) programs consists of a set of pre-, intra- and post-operative protocols to minimize perioperative burden, reduce postoperative complications and morbidity, optimize postoperative recovery, and shorten hospital stay. The rare studies available demonstrate positive results for long-term survival of ERAS in gastric, colon and rectal cancers, however, it is not clear whether the ERAS regimen can improve the long-term prognosis of esophageal cancer. Therefore, we conducted this study to compare post-operative morbidity, functional recovery, and length of hospital stay in patients undergoing esophagectomy following the implementation of modified ERAS (mERAS) protocols or conventional standard care (SC), and to determine the effect of the ERAS protocol after esophagectomy on long-term survival. Materials and methods: This retrospective clinical study was conducted from 1st June 2014 to 31st December 2016, included 229 consecutive patients with esophageal carcinoma who underwent esophagectomy. The mERAS protocols were implemented in our department of Fujian Medical University Union Hospital on 1st November 2015. After that time, all patients were treated according to the protocols (mERAS group). And before that time, all patients were treated with conventional standard care (SC group). We chose the cohort of patients, because the patients underwent surgery most recently prior to the patients in mERAS group. There was no significant difference between the two groups, with the exception of the percentage of patients who had cocomitant disease. The rate of cardiac diseases or hypertension in mERAS group was higher than that in SC group (24.4% vs. 13.8%). Incidence rate of anastomotic leakage was significantly lower in mERAS patients than in SC patients (0% vs. 13.8%, P = 0.000). Incidence rate of chylous leakage was significantly lower in mERAS patients than in SC patients (0.7% vs. 6.4%, P = 0.015). In patients with 5% preoperative weight loss, survival was better in the mERAS group than in the SC group. The advantage of ERAS concerns the surgeon, care team, the patient and the society as a whole. Our study indicated that implementation of mERAS protocols in patients undergoing minimally invasive esophagectomy could resulted in better postoperative recovery and reduced postoperative complications.