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Meta-Analysis
. 2025 Jan 7;38(1):doae118.
doi: 10.1093/dote/doae118.

Evaluating the impact of enhanced recovery after surgery protocols following oesophagectomy: a systematic review and meta-analysis of randomised clinical trials

Patrick Kennelly  1 , Matthew G Davey  1 , Diana Griniouk  1 , Gavin Calpin  1 , Noel E Donlon  1
Affiliations
Meta-Analysis

Evaluating the impact of enhanced recovery after surgery protocols following oesophagectomy: a systematic review and meta-analysis of randomised clinical trials

Patrick Kennelly et al. Dis Esophagus. .

Abstract

Enhanced Recovery After Surgery (ERAS) protocols are evidence-based care improvement pathways which are perceived to expedite patient recovery following surgery. Their utility in the setting of oesophagectomy remains unclear. The aim of this study was to perform a systematic review and meta-analysis of randomised clinical trials (RCTs) to evaluate the impact of ERAS protocols on recovery following oesophagectomy compared to standard care. A systematic review was performed in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines. Meta-analysis was performed using Review Manager (Version 5.4). Six RCTs including 850 patients were included in this meta-analysis. Overall complication rate (Odds Ratio (OR): 0.35, Confidence Interval (CI): 0.21, 0.59, P < 0.0001), pulmonary complications (OR: 0.40, CI: 0.24, 0.67, P = 0.0005), post-operative length of stay (LOS) (OR -1.88, CI -2.05, -1.70, P < 0.00001) and time to post-operative flatus (OR: -5.20, CI: -9.46, -0.95, P = 0.02) favoured the ERAS group. There was no difference noted for anastomotic leak (OR: 0.55, CI: 0.24, 1.28, P = 0.17), cardiac complications (OR: 0.86, CI: 0.30, 2.46, P = 0.78), gastrointestinal complications (OR: 0.51, CI: 0.23, 1.17, P = 0.11), wound complications (OR: 0.85, CI: 0.28, 2.58, P = 0.78), mortality (OR: 1.37, CI: 0.26, 7.4, P = 0.71), and 30-day re-admission rate (OR: 1.29, CI: 0.30, 5.47, P = 0.73) between ERAS and standard care groups. ERAS implementation improved post-operative complications, LOS, and time to flatus following oesphagectomy. These results support the robust adoption of ERAS in patients indicated to undergo oesphagectomy.

Keywords: ERAS; enhanced recovery after surgery; esophagectomy; oesophagectomy; patient outcomes.

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Conflict of interest statement

None to declare.

Figures

Figure 1
Figure 1
Prisma Flow Diagram
Figure 2
Figure 2
Forest plots for (A) overall complications, (B) anastomotic leak, and (C) pulmonary complications for comparison of enhanced recovery after surgery and standard care protocols following oesophagectomy
Figure 3
Figure 3
Forest plots for (A) cardiac complications, (B) gastrointestinal complications, and (C) wound complications for comparison of enhanced recovery after surgery and standard care protocols following oesophagectomy
Figure 4
Figure 4
Forest plots for (A) 30 day re-admission, (B) post-operative length of stay, (C) post operative flatus time, and (D) mortality for comparison of enhanced recovery after surgery and standard care protocols following oesophagectomy
See this image and copyright information in PMC

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