• Hideki Taniguchi, Toshio Sasaki, Hisae Fujita, Hiroko Kobayashi, Rieko Kawasaki, Takashi Ogata, Haruhiko Cho, Takaki Yoshikawa, Keiko Ushigome, Akemi Tanaka, and Osami Takano.
• Department of Nutrition, Faculty of Human Services, Kanagawa University of Human Services, 1-10-1 Heisei, Yokosuka, Kanagawa 238-8522, Japan. Electronic address: hstani@aol.jp.
• Clin Nutr ESPEN. 2018 Feb 1; 23: 184-193.

Background And AimsThe Enhanced Recovery after Surgery (ERAS) program has been proposed as a postoperative recovery-enhancing strategy. We frequently apply the Modified-ERAS program following oesophagectomy. This study aims to elucidate the impact of goal-directed fluid therapy (GDT) for the perioperative management of oesophageal cancer on the postoperative recovery of patients undergoing oesophagectomy.MethodsThis is an interventional before-after comparative observational study conducted at Kanagawa Cancer Centre, Japan. Patients who underwent elective oesophagectomy for oesophageal cancer were recruited. Group H (retrospectively collected) received intraoperative and postoperative management consisting of fluid administration without haemodynamic monitoring and the M-ERAS program, while Group S prospectively received management consisting of GDT and the M-ERAS program. The primary endpoint was the speed of gastrointestinal functional recovery, while secondary endpoints were the level of postoperative mobilisation, incidence of complications, postoperative length of hospital stay (LOS), and nutritional status after discharge.ResultsThe proportion of patients who completely egested Gastrografin by postoperative day 4, the level of postoperative mobilisation, and achievement ratio for a 100-m walk on the first postoperative attempt were significantly higher in Group S than in Group H (P = 0.034, P = 0.0197, and P < 0.0001, respectively). No significant differences were observed in the postoperative LOS and incidence of complications within 30 days between the groups. The serum albumin levels at 6 months after discharge was higher in Group S than in Group H (P = 0.0002).ConclusionsThe GDT-ERAS program enhanced postoperative gastrointestinal recovery and mobilisation, as well as postoperative nutritional status and protein synthesis. The program did not affect either postoperative LOS or the incidence of complications.Trial RegistrationUMIN registration number: UMIN000013705, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000015999.Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

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