ИСТИНА

Objectives: Esophagectomy is a high-risk procedure traditionally associated with high morbidity rate up to 40 % - 74 %. Effectiveness of the fast-track protocols nowadays are widely accepted in different fields of surgery. In a lot of papers it's maked the stress on “selected groups” of patients that could be included to ERAS programs. There are still limited investigations, describes enhanced recovery protocols for patients undergoing esophagectomy. Hereby we present our results in implementation of ERAS-concept based protocol for esophagectomy. Methods: Single-center prospective non-randomized trial. A total of 92 patients were reviewed, who had undergone esophagectomy between December 2012 and December 2015. The median age was 57 (47; 67) years with male predominance 67 (72,8 %). Patients were operated following esophageal cancer, benign stenosis and neuromuscular disease in 56 (60,9%), 25 (27,2%) and 11 (11,9%) cases respectively. Transhiatal and Mckeown esophagectomy rate was 50 (54,4 %) and 42 (45,6 %) respectively. Protocol description: preoperative - routinely counseling by ERAS team,no prolonged fasting; nutrition support, incentive spirometry, fluid and carbohydrates loading; Intraoperative - avoidance of salt and water overload, judicious use of vasopressors, protective lung ventilation, high-thoracic epidural analgesia,maintenance of normothermia; Postopearative - immediate or early extubation, avoidance of salt and water overload,daily weight measurement, multimodal analgesia, early mobilization, stimulation of gut motility, audit of compliance and outcomes. Results: Median postoperative stay was 8,5 (9,5; 10,5) days with median ICU stay 0,7 (0,6; 0,8) days. 51 (55,4 %)patients of 92 [CI: 45,2 % - 65,2 %] extubated immediately after surgery. In 9 (9,2 %) of 92 cases several pulmonary insufficiency (PaO2/FiO2<300 mmHg) was detected in first 3 days after surgery. There was no anastomotic leakage, while total 30-day morbidity rate (Dindo-Clavien I-II grade) was 35 (38 %) of 92 [CI: 28,8 % - 48,2 %] and mortality rate was 4 (4,3 %) of 92 [CI: 1,7 % - 10,6 %] respectively. Conclusion: Implementation of the perioperative care protocols based on ERAS guidelines promotes decrease of postoperative complication rate even in high risk patients undergoing esophagectomy.