Low Donald E, Allum William, De Manzoni Giovanni, Ferri Lorenzo, Immanuel Arul, Kuppusamy MadhanKumar, Law Simon, Lindblad Mats, Maynard Nick, Neal Joseph, Pramesh C S, Scott Mike, Mark Smithers B, Addor Valérie, Ljungqvist Olle
Head of Thoracic Surgery and Thoracic Oncology, C6-GS, Virginia Mason Medical Center, 1100 Ninth Ave, Seattle, WA, 98101, USA.
The Royal Marsden Hospitals, London, UK.
World J Surg. 2019 Feb;43(2):299-330. doi: 10.1007/s00268-018-4786-4.
Enhanced recovery after surgery (ERAS) programs provide a format for multidisciplinary care and has been shown to predictably improve short term outcomes associated with surgical procedures. Esophagectomy has historically been associated with significant levels of morbidity and mortality and as a result routine application and audit of ERAS guidelines specifically designed for esophageal resection has significant potential to improve outcomes associated with this complex procedure.
A team of international experts in the surgical management of esophageal cancer was assembled and the existing literature was identified and reviewed prior to the production of the guidelines. Well established procedure specific components of ERAS were reviewed and updated with changes relevant to esophagectomy. Procedure specific, operative and technical sections were produced utilizing the best current level of evidence. All sections were rated regarding the level of evidence and overall recommendation according to the evaluation (GRADE) system.
Thirty-nine sections were ultimately produced and assessed for quality of evidence and recommendations. Some sections were completely new to ERAS programs due to the fact that esophagectomy is the first guideline with a thoracic component to the procedure.
The current ERAS society guidelines should be reviewed and applied in all centers looking to improve outcomes and quality associated with esophageal resection.
加速康复外科（ERAS）计划提供了一种多学科护理模式，并且已被证明能够可预测地改善与外科手术相关的短期预后。传统上，食管切除术的发病率和死亡率一直很高，因此，专门为食管切除术设计的ERAS指南的常规应用和审核对于改善这一复杂手术的预后具有巨大潜力。
组建了一个由食管癌外科治疗国际专家组成的团队，在制定指南之前，对现有文献进行了识别和综述。对ERAS中成熟的特定手术组成部分进行了回顾，并根据与食管切除术相关的变化进行了更新。利用当前最佳证据水平编写了特定手术、手术操作和技术部分。根据评估（GRADE）系统对所有部分的证据水平和总体推荐进行评级。
最终编写了39个部分，并对证据质量和推荐意见进行了评估。由于食管切除术是首个包含胸部手术部分的指南，因此有些部分对于ERAS计划来说是全新的。
当前的ERAS协会指南应在所有希望改善食管切除术预后和质量的中心进行审查和应用。
