Abstract
INTRODUCTION: The benefits of the enhanced recovery after surgery (ERAS) protocol across surgeries are well documented, but its impact on esophageal cancer surgery remains understudied. This study compared the 3-year survival rates of esophagectomy patients treated with and without ERAS at a tertiary care hospital. METHODS: A retrospective analysis of 124 elective esophagectomy patients (Jan 2017-Jan 2022) was conducted. Patients with distant metastasis or had concurrent hypopharynx cancer that needed pharyngectomy were excluded from analysis. Patients treated before April 2019 received standard care, while those treated from April 2019 followed the ERAS protocol. Multivariate Cox regression analysis identified potential prognostic factors for overall survival. Survival associations were determined using the Kaplan-Meier(K-M) method and log-rank tests. The primary outcome was 3-year overall survival, and the secondary outcomes were postoperative intensive care unit (ICU) stay, hospital length of stay (LOS), and complications. RESULTS: We analyzed 58 patients in the control group and 66 patients in the ERAS group. The ERAS group demonstrated significantly lower 3-year overall mortality compared to the control group in multivariate Cox regression (adjusted hazard ratio: 0.44, 95% CI: 0.22-0.88, p = 0.020). Advanced pathologic cancer stage and neoadjuvant chemoradiation therapy (CCRT) were independent negative prognostic factors (adjusted hazard ratio for advanced pathological stage: 2.91, 95% CI: 1.27-6.66, p = 0.011; for neoadjuvant CCRT: 2.73, 95% CI: 1.23-6.08, p = 0.013). Kaplan-Meier survival analysis showed a significantly higher 3-year survival rate in the ERAS group compared to the control group (70.2% vs. 47.4%, p = 0.043). Subgroup analysis revealed significant survival benefits of ERAS in patients with preoperative albumin concentration < 4 g/dl, advanced pathological stage and aged < 65 years. Additionally, the ERAS group had significantly shorter ICU stays (mean difference: -2.3 days, p < 0.001), shorter hospital LOSs (mean difference: -4.9 days, p < 0.001), while postoperative complication rates were comparable between two groups. CONCLUSIONS: The ERAS protocol in esophagectomy patients was associated with shorter ICU and hospital stays and emerged as an independent positive prognostic factor for 3-year overall survival. These results suggest ERAS might indirectly improve long-term survival by accelerating recovery, thereby enabling patients to better tolerate and complete essential postoperative oncological treatments. Nevertheless, larger prospective studies are required to validate this interpretation conclusively.