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Enhanced recovery pathways vs standard care pathways in esophageal cancer surgery: systematic review and meta-analysis

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Abstract

Enhanced recovery after surgery (ERAS) protocols vs standard care pathways after esophagectomy for malignancy have gained wide popularity among surgeons. However, the current literature is still lacking level-I evidence to show a clear superiority of one approach. The present study is a detailed systematic review and meta-analysis of the published trials. A systematic review of literature databases was conducted for randomized controlled trials (RCTs) and non-randomized, prospective, comparative studies between January 1990 and September 2019, comparing ERAS pathway group with standard care for esophageal resection for esophageal cancer. Mean difference (MD) for continuous variables and odds ratio (OR) or risk difference (RD) for dichotomous variables with 95% confidence interval (CI) were used. Between-study heterogeneity was evaluated. Eight studies with a total of 1133 patients were included. Hospital stay [Standard mean difference (Std. MD) = − 1.92, 95% CI − 2.78, − 1.06, P < 0.0001], overall morbidity (OR 0.68, CI 0.49, 0.96, P = 0.03), pulmonary complications (OR 0.45, CI 0.31, 0.65, P < 0.0001), anastomotic leak rate (OR 0.37, CI 0.18, 0.74, P = 0.005), time to first flatus and defecation (Std. MD = -5.01, CI − 9.53, − 0.49, P = 0.03), (Std. MD = − 1.36, CI − 1.78, − 0.94, P < 0.00001) and total hospital cost (Std. MD = − 1.62, CI − 2.24, − 1.01, P < 0.00001) favored the ERAS group. Patients who undergo ERAS have a clear benefit over the standard care protocol. However, existing protocols in different centers are followed by great variability, while the evaluated parameters suffer from significant heterogeneity. A well-formulated, standardized protocol should be standard-of-care at all centers.

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Authors and Affiliations

  1. 1st Propaedeutic Department of Surgery, Hippocration General Hospital of Athens, University of Athens, Athens, Greece

    Tania Triantafyllou & Dimitrios Theodorou

  2. University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA

    Michael T. Olson

  3. First Department of Surgery, Laikon General Hospital of Athens, Athens, Greece

    Dimitrios Schizas

  4. Department of GI Surgery and Liver Transplantation, Indraprastha Apollo Hospital, New Delhi, India

    Saurabh Singhal

Authors
  1. Tania Triantafyllou
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  2. Michael T. Olson
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  3. Dimitrios Theodorou
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  4. Dimitrios Schizas
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  5. Saurabh Singhal
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Contributions

TT and SS reviewed the literature, completed data collection and contributed in writing the manuscript. MO contributed in writing the manuscript and provided extensive editing and proofreading. DS reviewed the literature and collected the articles. DT reviewed the manuscript and contributed in interpretation and analysis of the data. SS performed the statistical analysis and provided writing assistance and proof reading of the article. SS provided administrative support. TT and SS provided supervision and conception, and are responsible of final approval and accountability for all aspects of work.

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Correspondence to Saurabh Singhal.

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Each individual listed as an author on this manuscript contributed substantially and in accordance with the guidelines of the International Committee of Medical Journal Editors.

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Table S1.

PRISMA Checklist (DOCX 25 kb)

Table S2.

Risk of Bias Assessment for Observational Studies (ROBINS-I Tool) (DOCX 13 kb)

Table S3.

Risk of Bias Assessment for Randomized Studies (Cochrane Tool) (DOCX 12 kb)

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Triantafyllou, T., Olson, M.T., Theodorou, D. et al. Enhanced recovery pathways vs standard care pathways in esophageal cancer surgery: systematic review and meta-analysis. Esophagus 17, 100–112 (2020). https://doi.org/10.1007/s10388-020-00718-9

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  • DOI: https://doi.org/10.1007/s10388-020-00718-9

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