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World J Surg. 2019 Feb;43(2):299-330. doi: 10.1007/s00268-018-4786-4.

Guidelines for Perioperative Care in Esophagectomy: Enhanced Recovery After Surgery (ERAS®) Society Recommendations.

Author information

1
Head of Thoracic Surgery and Thoracic Oncology, C6-GS, Virginia Mason Medical Center, 1100 Ninth Ave, Seattle, WA, 98101, USA. donald.low@vmmc.org.
2
The Royal Marsden Hospitals, London, UK.
3
University of Verona, Verona, Italy.
4
McGill University Health Centre, Montreal, Canada.
5
Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK.
6
Head of Thoracic Surgery and Thoracic Oncology, C6-GS, Virginia Mason Medical Center, 1100 Ninth Ave, Seattle, WA, 98101, USA.
7
Queen Mary Hospital, Hong Kong, China.
8
Karolinska Institutet, Stockholm, Sweden.
9
Oxford Radcliffe Hospitals, Oxford, UK.
10
Tata Memorial Centre, Mumbai, India.
11
Virginia Commonwealth University Health System, Richmond, VA, USA.
12
Princess Alexandra Hospital, The University of Queensland, Brisbane, Australia.
13
Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
14
Örebro University, Örebro, Sweden.

Abstract

INTRODUCTION:

Enhanced recovery after surgery (ERAS) programs provide a format for multidisciplinary care and has been shown to predictably improve short term outcomes associated with surgical procedures. Esophagectomy has historically been associated with significant levels of morbidity and mortality and as a result routine application and audit of ERAS guidelines specifically designed for esophageal resection has significant potential to improve outcomes associated with this complex procedure.

METHODS:

A team of international experts in the surgical management of esophageal cancer was assembled and the existing literature was identified and reviewed prior to the production of the guidelines. Well established procedure specific components of ERAS were reviewed and updated with changes relevant to esophagectomy. Procedure specific, operative and technical sections were produced utilizing the best current level of evidence. All sections were rated regarding the level of evidence and overall recommendation according to the evaluation (GRADE) system.

RESULTS:

Thirty-nine sections were ultimately produced and assessed for quality of evidence and recommendations. Some sections were completely new to ERAS programs due to the fact that esophagectomy is the first guideline with a thoracic component to the procedure.

CONCLUSIONS:

The current ERAS society guidelines should be reviewed and applied in all centers looking to improve outcomes and quality associated with esophageal resection.

PMID:
30276441
DOI:
10.1007/s00268-018-4786-4
[Indexed for MEDLINE]

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