The application and progress of enhanced recovery after surgery in the surgical treatment of esophageal cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LUAN Yujie ^1,2 , SHI Qingtong ¹ ,  BAO Yang ¹

1. Department of Thoracic Surgery, Affiliated Hospital of Yangzhou University, Yangzhou, 225000, Jiangsu, P. R. China;
2. Graduate School, Dalian Medical University, Dalian, 116044, Liaoning, P. R. China;

Corresponding author：

BAO Yang, Email: baoyang@yzu.edu.cn

Keywords：

Enhanced recovery after surgery; esophageal cancer; surgical treatment; review

DOI：

10.7507/1007-4848.202207026

Video：

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Abstract Full text Figures/Tables Video References Cited by

Esophageal cancer threatens the lives and health of humans for a long time owing to its high morbidity and mortality. Surgical treatment is still the first choice for early-stage esophageal cancer now, but its high mortality and complication rate during perioperative period cause a huge physiological and psychological burden on patients. The concept of enhanced recovery after surgery (ERAS) was first proposed for colorectal surgery, and later promoted to other surgical fields. Its application in esophagectomy successfully reduces the high mortality and complication rate in the perioperative stage and promotes the rapid recovery of patients. However, the application of ERAS in the field of esophageal cancer is relatively late, and its promotion and application are relatively limited compared to other surgical procedures. In this paper, we review the relevant literature at home and abroad in combination with the current progress of ERAS application of esophageal cancer in China. We also summarize the relevant problems related to the implementation of ERAS, in order to help the promotion and application of ERAS in the surgical treatment of esophageal cancer.

Citation： LUAN Yujie, SHI Qingtong, BAO Yang. The application and progress of enhanced recovery after surgery in the surgical treatment of esophageal cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(3): 454-461. doi: 10.7507/1007-4848.202207026 Copy

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3.	Watanabe M, Otake R, Kozuki R, et al. Recent progress in multidisciplinary treatment for patients with esophageal cancer. Surg Today, 2020, 50(1): 12-20.
4.	Fujishiro M, Kodashima S. Indications, techniques, and outcomes of endoscopic submucosal dissection for esophageal squamous cell carcinoma. Esophagus, 2009, 6(3): 143-148.
5.	Stahl M, Mariette C, Haustermans K, et al. Oesophageal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2013, 24 Suppl 6: vi51-vi56.
6.	Lerut T, Wiesel O. History of esophagectomy for cancer of the esophagus and the gastroesophageal junction. Ann Transl Med, 2021, 9(10): 897.
7.	Low DE, Allum W, De Manzoni G, et al. Guidelines for perioperative care in esophagectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. World J Surg, 2019, 43(2): 299-330.
8.	Ashok A, Niyogi D, Ranganathan P, et al. The enhanced recovery after surgery (ERAS) protocol to promote recovery following esophageal cancer resection. Surg Today, 2020, 50(4): 323-334.
9.	Nevo Y, Arjah S, Katz A, et al. ERAS 2.0: Continued refinement of an established enhanced recovery protocol for esophagectomy. Ann Surg Oncol, 2021, 28(9): 4850-4858.
10.	中国医师协会胸外科分会快速康复专家委员会. 食管癌加速康复外科技术应用专家共识(2016版). 中华胸心血管外科杂志, 2016, 32(12): 717-722.
11.	Lakananurak N, Gramlich L. The role of preoperative parenteral nutrition. Nutrients, 2020, 12(5): 1320.
12.	Shen Y, Zhou Y, He T, et al. Effect of preoperative nutritional risk screening and enteral nutrition support in accelerated recovery after resection for esophageal cancer. Nutr Cancer, 2021, 73(4): 596-601.
13.	Taberna M, Gil Moncayo F, Jané-Salas E, et al. The multidisciplinary team (MDT) approach and quality of care. Front Oncol, 2020, 10: 85.
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15.	Kawata S, Hiramatsu Y, Shirai Y, et al. Multidisciplinary team management for prevention of pneumonia and long-term weight loss after esophagectomy: A single-center retrospective study. Esophagus, 2020, 17(3): 270-278.
16.	Shirakawa Y, Noma K, Maeda N, et al. Early intervention of the perioperative multidisciplinary team approach decreases the adverse events during neoadjuvant chemotherapy for esophageal cancer patients. Esophagus, 2021, 18(4): 797-805.
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18.	Rajaei M, Bosarge PL, Griffin RL, et al. Impact of glycemic control on risk of mortality and complications in trauma patients. Shock, 2020, 54(1): 30-34.
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20.	Coffey MR, Bachman KC, Worrell SG, et al. Concurrent diagnosis of anxiety increases postoperative length of stay among patients receiving esophagectomy for esophageal cancer. Psychooncology, 2021, 30(9): 1514-1524.
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24.	Kendall F, Oliveira J, Peleteiro B, et al. Inspiratory muscle training is effective to reduce postoperative pulmonary complications and length of hospital stay: A systematic review and meta-analysis. Disabil Rehabil, 2018, 40(8): 864-882.
25.	刘子嘉, 张路, 刘洪生, 等. 基于加速术后康复的胸外科手术预康复管理专家共识(2022). 协和医学杂志, 2022, 13(3): 387-401.
26.	Becke-Jakob K, Eich CB. Preoperative fluid fasting-safety, homeostasis and well-being. Anaesthesist, 2021, 70(6): 466-468.
27.	Yilmaz M, Çelik M. The effects of preoperative fasting on patients undergoing thoracic surgery. J Perianesth Nurs, 2021, 36(2): 167-173.
28.	Lin MW, Chen CI, Cheng TT, et al. Prolonged preoperative fasting induces postoperative insulin resistance by ER-stress mediated glut4 down-regulation in skeletal muscles. Int J Med Sci, 2021, 18(5): 1189-1197.
29.	Dobson G, Chow L, Filteau L, et al. Guidelines to the practice of anesthesia: Revised edition 2021. Can J Anaesth, 2021, 68(1): 92-129.
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32.	Wendling AL, Byun SY, Koenig M, et al. Impact of oral carbohydrate consumption prior to cesarean delivery on preoperative well-being: A randomized interventional study. Arch Gynecol Obstet, 2020, 301(1): 179-187.
33.	Kakeji Y, Oshikiri T, Takiguchi G, et al. Multimodality approaches to control esophageal cancer: Development of chemoradiotherapy, chemotherapy, and immunotherapy. Esophagus, 2021, 18(1): 25-32.
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36.	Tian D, Zhang L, Wang Y, et al. Neoadjuvant chemotherapy with irinotecan and nedaplatin in a single cycle followed by esophagectomy on cT4 resectable esophageal squamous cell carcinoma: A prospective nonrandomized trial for short-term outcomes. Dis Esophagus, 2019, 32(3): doy080.
37.	Klevebro F, Nilsson K, Lindblad M, et al. Association between time interval from neoadjuvant chemoradiotherapy to surgery and complete histological tumor response in esophageal and gastroesophageal junction cancer: A national cohort study. Dis Esophagus, 2020, 33(5): doz078.
38.	Mariette C, Markar SR, Dabakuyo-Yonli TS, et al. Hybrid minimally invasive esophagectomy for esophageal cancer. N Engl J Med, 2019, 380(2): 152-162.
39.	van der Sluis PC, van der Horst S, May AM, et al. Robot-assisted minimally invasive thoracolaparoscopic esophagectomy versus open transthoracic esophagectomy for resectable esophageal cancer: A randomized controlled trial. Ann Surg, 2019, 269(4): 621-630.
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45.	Zhu AC, Agarwala A, Bao X. Perioperative fluid management in the enhanced recovery after surgery (ERAS) pathway. Clin Colon Rectal Surg, 2019, 32(2): 114-120.
46.	Brandstrup B, Tønnesen H, Beier-Holgersen R, et al. Effects of intravenous fluid restriction on postoperative complications: Comparison of two perioperative fluid regimens: A randomized assessor-blinded multicenter trial. Ann Surg, 2003, 238(5): 641-648.
47.	Fang L, Zheng H, Yu W, et al. Effects of intraoperative fluid management on postoperative outcomes after pericardiectomy. Front Surg, 2021, 8: 673466.
48.	Hikasa Y, Suzuki S, Mihara Y, et al. Intraoperative fluid therapy and postoperative complications during minimally invasive esophagectomy for esophageal cancer: A single-center retrospective study. J Anesth, 2020, 34(3): 404-412.
49.	Joosten A, Rinehart J, Van der Linden P, et al. Computer-assisted individualized hemodynamic management reduces intraoperative hypotension in intermediate- and high-risk surgery: A randomized controlled trial. Anesthesiology, 2021, 135(2): 258-272.
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51.	Wagener G, Bezinover D, Wang C, et al. Fluid management during kidney transplantation: A consensus statement of the Committee on Transplant Anesthesia of the American Society of Anesthesiologists. Transplantation, 2021, 105(8): 1677-1684.
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1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Li J, Xu J, Zheng Y, et al. Esophageal cancer: Epidemiology, risk factors and screening. Chin J Cancer Res, 2021, 33(5): 535-547.
3. Watanabe M, Otake R, Kozuki R, et al. Recent progress in multidisciplinary treatment for patients with esophageal cancer. Surg Today, 2020, 50(1): 12-20.
4. Fujishiro M, Kodashima S. Indications, techniques, and outcomes of endoscopic submucosal dissection for esophageal squamous cell carcinoma. Esophagus, 2009, 6(3): 143-148.
5. Stahl M, Mariette C, Haustermans K, et al. Oesophageal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2013, 24 Suppl 6: vi51-vi56.
6. Lerut T, Wiesel O. History of esophagectomy for cancer of the esophagus and the gastroesophageal junction. Ann Transl Med, 2021, 9(10): 897.
7. Low DE, Allum W, De Manzoni G, et al. Guidelines for perioperative care in esophagectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. World J Surg, 2019, 43(2): 299-330.
8. Ashok A, Niyogi D, Ranganathan P, et al. The enhanced recovery after surgery (ERAS) protocol to promote recovery following esophageal cancer resection. Surg Today, 2020, 50(4): 323-334.
9. Nevo Y, Arjah S, Katz A, et al. ERAS 2.0: Continued refinement of an established enhanced recovery protocol for esophagectomy. Ann Surg Oncol, 2021, 28(9): 4850-4858.
10. 中国医师协会胸外科分会快速康复专家委员会. 食管癌加速康复外科技术应用专家共识(2016版). 中华胸心血管外科杂志, 2016, 32(12): 717-722.
11. Lakananurak N, Gramlich L. The role of preoperative parenteral nutrition. Nutrients, 2020, 12(5): 1320.
12. Shen Y, Zhou Y, He T, et al. Effect of preoperative nutritional risk screening and enteral nutrition support in accelerated recovery after resection for esophageal cancer. Nutr Cancer, 2021, 73(4): 596-601.
13. Taberna M, Gil Moncayo F, Jané-Salas E, et al. The multidisciplinary team (MDT) approach and quality of care. Front Oncol, 2020, 10: 85.
14. Davies AR, Deans DA, Penman I, et al. The multidisciplinary team meeting improves staging accuracy and treatment selection for gastro-esophageal cancer. Dis Esophagus, 2006, 19(6): 496-503.
15. Kawata S, Hiramatsu Y, Shirai Y, et al. Multidisciplinary team management for prevention of pneumonia and long-term weight loss after esophagectomy: A single-center retrospective study. Esophagus, 2020, 17(3): 270-278.
16. Shirakawa Y, Noma K, Maeda N, et al. Early intervention of the perioperative multidisciplinary team approach decreases the adverse events during neoadjuvant chemotherapy for esophageal cancer patients. Esophagus, 2021, 18(4): 797-805.
17. Okamura A, Watanabe M, Imamura Y, et al. Glycemic status and prognosis of patients with squamous cell carcinoma of the esophagus. World J Surg, 2017, 41(10): 2591-2597.
18. Rajaei M, Bosarge PL, Griffin RL, et al. Impact of glycemic control on risk of mortality and complications in trauma patients. Shock, 2020, 54(1): 30-34.
19. Altinsoy S, Caparlar CO, Ergil J. The relation between preoperative anxiety and awareness during anesthesia: An observational study. Braz J Anesthesiol, 2020, 70(4): 349-356.
20. Coffey MR, Bachman KC, Worrell SG, et al. Concurrent diagnosis of anxiety increases postoperative length of stay among patients receiving esophagectomy for esophageal cancer. Psychooncology, 2021, 30(9): 1514-1524.
21. Ohkura Y, Ichikura K, Shindoh J, et al. Relationship between psychological distress and health-related quality of life at each point of the treatment of esophageal cancer. Esophagus, 2020, 17(3): 312-322.
22. Sheill G, Guinan E, O'Neill L, et al. Preoperative exercise to improve fitness in patients undergoing complex surgery for cancer of the lung or oesophagus (PRE-HIIT): Protocol for a randomized controlled trial. BMC Cancer, 2020, 20(1): 321.
23. Argudo N, Rodó-Pin A, Martínez-Llorens J, et al. Feasibility, tolerability, and effects of exercise-based prehabilitation after neoadjuvant therapy in esophagogastric cancer patients undergoing surgery: An interventional pilot study. Dis Esophagus, 2021, 34(4): doaa086.
24. Kendall F, Oliveira J, Peleteiro B, et al. Inspiratory muscle training is effective to reduce postoperative pulmonary complications and length of hospital stay: A systematic review and meta-analysis. Disabil Rehabil, 2018, 40(8): 864-882.
25. 刘子嘉, 张路, 刘洪生, 等. 基于加速术后康复的胸外科手术预康复管理专家共识(2022). 协和医学杂志, 2022, 13(3): 387-401.
26. Becke-Jakob K, Eich CB. Preoperative fluid fasting-safety, homeostasis and well-being. Anaesthesist, 2021, 70(6): 466-468.
27. Yilmaz M, Çelik M. The effects of preoperative fasting on patients undergoing thoracic surgery. J Perianesth Nurs, 2021, 36(2): 167-173.
28. Lin MW, Chen CI, Cheng TT, et al. Prolonged preoperative fasting induces postoperative insulin resistance by ER-stress mediated glut4 down-regulation in skeletal muscles. Int J Med Sci, 2021, 18(5): 1189-1197.
29. Dobson G, Chow L, Filteau L, et al. Guidelines to the practice of anesthesia: Revised edition 2021. Can J Anaesth, 2021, 68(1): 92-129.
30. 中华医学会外科学分会, 中华医学会麻醉学分会. 中国加速康复外科临床实践指南(2021版). 中国实用外科杂志, 2021, 41(9): 961-992.
31. Bilku DK, Dennison AR, Hall TC, et al. Role of preoperative carbohydrate loading: A systematic review. Ann R Coll Surg Engl, 2014, 96(1): 15-22.
32. Wendling AL, Byun SY, Koenig M, et al. Impact of oral carbohydrate consumption prior to cesarean delivery on preoperative well-being: A randomized interventional study. Arch Gynecol Obstet, 2020, 301(1): 179-187.
33. Kakeji Y, Oshikiri T, Takiguchi G, et al. Multimodality approaches to control esophageal cancer: Development of chemoradiotherapy, chemotherapy, and immunotherapy. Esophagus, 2021, 18(1): 25-32.
34. Yang H, Liu H, Chen Y, et al. Long-term efficacy of neoadjuvant chemoradiotherapy plus surgery for the treatment of locally advanced esophageal squamous cell carcinoma: The NEOCRTEC5010 randomized clinical trial. JAMA Surg, 2021, 156(8): 721-729.
35. Wang H, Tang H, Fang Y, et al. Morbidity and mortality of patients who underwent minimally invasive esophagectomy after neoadjuvant chemoradiotherapy vs. neoadjuvant chemotherapy for locally advanced esophageal squamous cell carcinoma: A randomized clinical trial. JAMA Surg, 2021, 156(5): 444-451.
36. Tian D, Zhang L, Wang Y, et al. Neoadjuvant chemotherapy with irinotecan and nedaplatin in a single cycle followed by esophagectomy on cT4 resectable esophageal squamous cell carcinoma: A prospective nonrandomized trial for short-term outcomes. Dis Esophagus, 2019, 32(3): doy080.
37. Klevebro F, Nilsson K, Lindblad M, et al. Association between time interval from neoadjuvant chemoradiotherapy to surgery and complete histological tumor response in esophageal and gastroesophageal junction cancer: A national cohort study. Dis Esophagus, 2020, 33(5): doz078.
38. Mariette C, Markar SR, Dabakuyo-Yonli TS, et al. Hybrid minimally invasive esophagectomy for esophageal cancer. N Engl J Med, 2019, 380(2): 152-162.
39. van der Sluis PC, van der Horst S, May AM, et al. Robot-assisted minimally invasive thoracolaparoscopic esophagectomy versus open transthoracic esophagectomy for resectable esophageal cancer: A randomized controlled trial. Ann Surg, 2019, 269(4): 621-630.
40. Shang QX, Wang YC, Yang YS, et al. Pattern of subcarinal lymph node metastasis and dissection strategy for thoracic esophageal cancer. J Thorac Dis, 2020, 12(10): 5667-5677.
41. Deng XM, Zhu TY, Wang GJ, et al. Lymph node metastasis pattern and significance of left gastric artery lymph node dissection in esophagectomy for esophageal cancers. World J Surg Oncol, 2021, 19(1): 296.
42. Wang Z, Mao Y, Gao S, et al. Lymph node dissection and recurrent laryngeal nerve protection in minimally invasive esophagectomy. Ann N Y Acad Sci, 2020, 1481(1): 20-29.
43. Otsuka K, Murakami M, Goto S, et al. Minimally invasive esophagectomy and radical lymph node dissection without recurrent laryngeal nerve paralysis. Surg Endosc, 2020, 34(6): 2749-2757.
44. Makaryus R, Miller TE, Gan TJ. Current concepts of fluid management in enhanced recovery pathways. Br J Anaesth, 2018, 120(2): 376-383.
45. Zhu AC, Agarwala A, Bao X. Perioperative fluid management in the enhanced recovery after surgery (ERAS) pathway. Clin Colon Rectal Surg, 2019, 32(2): 114-120.
46. Brandstrup B, Tønnesen H, Beier-Holgersen R, et al. Effects of intravenous fluid restriction on postoperative complications: Comparison of two perioperative fluid regimens: A randomized assessor-blinded multicenter trial. Ann Surg, 2003, 238(5): 641-648.
47. Fang L, Zheng H, Yu W, et al. Effects of intraoperative fluid management on postoperative outcomes after pericardiectomy. Front Surg, 2021, 8: 673466.
48. Hikasa Y, Suzuki S, Mihara Y, et al. Intraoperative fluid therapy and postoperative complications during minimally invasive esophagectomy for esophageal cancer: A single-center retrospective study. J Anesth, 2020, 34(3): 404-412.
49. Joosten A, Rinehart J, Van der Linden P, et al. Computer-assisted individualized hemodynamic management reduces intraoperative hypotension in intermediate- and high-risk surgery: A randomized controlled trial. Anesthesiology, 2021, 135(2): 258-272.
50. Giustiniano E, Procopio F, Ruggieri N, et al. Impact of the FloTrac/VigileoTM monitoring on intraoperative fluid management and outcome after liver resection. Dig Surg, 2018, 35(5): 435-441.
51. Wagener G, Bezinover D, Wang C, et al. Fluid management during kidney transplantation: A consensus statement of the Committee on Transplant Anesthesia of the American Society of Anesthesiologists. Transplantation, 2021, 105(8): 1677-1684.
52. Peng K, Liu HY, Wu SR, et al. Effects of combining dexmedetomidine and opioids for postoperative intravenous patient-controlled analgesia: A systematic review and meta-analysis. Clin J Pain, 2015, 31(12): 1097-1104.
53. Simpson JC, Bao X, Agarwala A. Pain management in enhanced recovery after surgery (ERAS) protocols. Clin Colon Rectal Surg, 2019, 32(2): 121-128.
54. Kingma BF, Visser E, Marsman M, et al. Epidural analgesia after minimally invasive esophagectomy: Efficacy and complication profile. Dis Esophagus, 2019, 32(8): doy116.
55. Chen N, Qiao Q, Chen R, et al. The effect of ultrasound-guided intercostal nerve block, single-injection erector spinae plane block and multiple-injection paravertebral block on postoperative analgesia in thoracoscopic surgery: A randomized, double-blinded, clinical trial. J Clin Anesth, 2020, 59: 106-111.
56. Choi BM, Hwang CS, Yoon YS, et al. Novel temperature-responsive hydrogel injected to the incision site for postoperative pain relief in laparoscopic abdominal surgery: A single-blind, randomized, pivotal clinical trial. Surg Endosc, 2022, 36(8): 5794-5802.
57. Ravindhran B, Rajan S, Balachandran G, et al. Do ice packs reduce postoperative midline incision pain, NSAID or narcotic use? World J Surg, 2019, 43(11): 2651-2657.
58. Wu MS, Chen KH, Chen IF, et al. The efficacy of acupuncture in post-operative pain management: A systematic review and meta-analysis. PLoS One, 2016, 11(3): e0150367.
59. Lopes LP, Menezes TM, Toledo DO, et al. Early oral feeding post-upper gastrointestinal tract resection and primary anastomosis in oncology. Arq Bras Cir Dig, 2018, 31(1): e1359.
60. Jang A, Jeong O. Tolerability of early oral nutrition and factors predicting early oral nutrition failure after gastrectomy. Clin Nutr, 2020, 39(11): 3331-3336.
61. Sun DL, Qi YX, Yang T, et al. Early oral nutrition improves postoperative ileus through the TRPA1/CCK1-R-mediated mast cell-nerve axis. Ann Transl Med, 2020, 8(5): 179.
62. Li R, Chen N, Ye C, et al. Risk factors for postoperative deep venous thrombosis in patients underwent craniotomy. Zhong Nan Da Xue Xue Bao Yi Xue Ban, 2020, 45(4): 395-399.
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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The application and progress of enhanced recovery after surgery in the surgical treatment of esophageal cancer

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