Our Summary

This research paper discusses a program called Enhanced Recovery After Surgery (ERAS), which improves patient outcomes after surgery by providing a structured, multidisciplinary approach to care. The focus of this study is on esophagectomy, a complex surgical procedure to remove part of the esophagus, which historically has had high rates of complications and death. The team of international experts reviewed existing literature and updated ERAS guidelines to make them relevant to esophagectomy. They created 39 sections on specific procedures, operations, and techniques, all of which were evaluated for their evidence and recommendations. Some of these sections were entirely new, as this is the first time ERAS guidelines have included a thoracic (relating to the chest) component. The researchers conclude that all medical centers performing esophagectomies should use these ERAS guidelines to improve patient outcomes and overall quality of care.

FAQs

  1. What is the Enhanced Recovery After Surgery (ERAS) program?
  2. What changes were made to the ERAS guidelines in relation to esophagectomy?
  3. Why is it recommended for all medical centers performing esophagectomies to use the updated ERAS guidelines?

Doctor’s Tip

One helpful tip a doctor might tell a patient about esophagectomy is to closely follow the Enhanced Recovery After Surgery (ERAS) guidelines, as they have been shown to improve patient outcomes and overall quality of care following this complex surgical procedure. This may include specific instructions on pre-operative preparation, pain management, nutrition, mobility, and other aspects of post-operative care. By adhering to these guidelines, patients can potentially reduce their risk of complications and have a smoother recovery process.

Suitable For

Patients who are typically recommended for esophagectomy include those with esophageal cancer, Barrett’s esophagus, severe gastroesophageal reflux disease (GERD), esophageal strictures, and other conditions that affect the esophagus. Esophagectomy may be recommended when other treatments have been ineffective or when the cancer or condition is advanced and requires surgical intervention. Patients who are deemed fit for surgery and are able to tolerate the procedure and post-operative care are usually considered candidates for esophagectomy.

Timeline

Before an esophagectomy, a patient typically undergoes a series of tests and evaluations to determine the extent of their condition and whether surgery is the best treatment option. This may include imaging tests, such as CT scans or endoscopy, as well as discussions with a multidisciplinary team of healthcare providers.

After the decision is made to proceed with an esophagectomy, the patient will undergo preoperative preparations, which may include dietary restrictions, medication adjustments, and possibly a period of nutritional support to optimize their health for surgery.

During the surgery itself, the patient will be under general anesthesia and the surgeon will remove the affected part of the esophagus, as well as potentially some surrounding tissue and lymph nodes. The remaining part of the esophagus is then reconnected to the stomach or another part of the digestive system.

After the surgery, the patient will typically spend some time in the intensive care unit (ICU) for monitoring and pain management. They may also have a feeding tube inserted to provide nutrition while the esophagus heals.

In the postoperative period, the patient will gradually resume eating and drinking, with the goal of eventually returning to a normal diet. They will also begin a rehabilitation program to improve their strength and endurance.

Overall, the recovery process after an esophagectomy can be lengthy and challenging, but with proper care and support, patients can achieve good outcomes and improved quality of life. The ERAS guidelines mentioned in the research paper can help healthcare providers optimize care for patients undergoing esophagectomy and improve their overall recovery experience.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with esophagectomy?

  2. How long is the recovery process after esophagectomy?

  3. What can I expect in terms of pain management following the surgery?

  4. Will I need to make any lifestyle changes or follow a specific diet after the procedure?

  5. How long will I need to stay in the hospital after the surgery?

  6. What is the success rate of esophagectomy in terms of long-term outcomes?

  7. Are there any alternative treatment options to esophagectomy that I should consider?

  8. What type of follow-up care will be necessary after the surgery?

  9. How experienced is the surgical team in performing esophagectomies?

  10. Are there any specific pre-operative preparations or tests that I need to undergo before the surgery?

Reference

Authors: Low DE, Allum W, De Manzoni G, Ferri L, Immanuel A, Kuppusamy M, Law S, Lindblad M, Maynard N, Neal J, Pramesh CS, Scott M, Mark Smithers B, Addor V, Ljungqvist O. Journal: World J Surg. 2019 Feb;43(2):299-330. doi: 10.1007/s00268-018-4786-4. PMID: 30276441