Supportive Care in Cancer

, Volume 26, Issue 6, pp 2057–2062 | Cite as

An investigation into the nutritional status of patients receiving an Enhanced Recovery After Surgery (ERAS) protocol versus standard care following Oesophagectomy

  • Katie BentonEmail author
  • Iain Thomson
  • Elisabeth Isenring
  • B. Mark Smithers
  • Ekta Agarwal
Original Article



Enhanced Recovery After Surgery (ERAS) protocols have been effectively expanded to various surgical specialities including oesophagectomy. Despite nutrition being a key component, actual nutrition outcomes and specific guidelines are lacking. This cohort comparison study aims to compare nutritional status and adherence during implementation of a standardised post-operative nutritional support protocol, as part of ERAS, compared to those who received usual care.


Two groups of patients undergoing resection of oesophageal cancer were studied. Group 1 (n = 17) underwent oesophagectomy between Oct 2014 and Nov 2016 during implementation of an ERAS protocol. Patients in group 2 (n = 16) underwent oesophagectomy between Jan 2011 and Dec 2012 prior to the implementation of ERAS. Demographic, nutritional status, dietary intake and adherence data were collected. Ordinal data was analysed using independent t tests, and categorical data using chi-square tests.


There was no significant difference in nutrition status, dietary intake or length of stay following implementation of an ERAS protocol. Malnutrition remained prevalent in both groups at day 42 post surgery (n = 10, 83% usual care; and n = 9, 60% ERAS). A significant difference was demonstrated in adherence with earlier initiation of oral free fluids (p <0.008), transition to soft diet (p <0.004) and continuation of jejunostomy feeds on discharge (p <0.000) for the ERAS group.


A standardised post-operative nutrition protocol, within an ERAS framework, results in earlier transition to oral intake; however, malnutrition remains prevalent post surgery. Further large-scale studies are warranted to examine individualised decision-making regarding nutrition support within an ERAS protocol.


Oesophagectomy Enhanced recovery after surgery Nutrition Early oral feeding 


Funding source

The study received funding from Allied Health Professions Office of Queensland, Health Practitioner Research Grant Scheme (internal grant awarded by the principal investigator). The funding source was not involved in any element of the study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Stavrou EP, Ward R, Pearson S-A (2012) Oesophagectomy rates and post-resection outcomes in patients with cancer of the oesophagus and gastro-oesophageal junction: a population-based study using linked health administrative linked data. BMC Health Serv Res 12(1):384. CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Baker M, Halliday V, Williams RN, Bowrey DJ (2016) A systematic review of the nutritional consequences of esophagectomy. Clin Nutr 35(5):987–994. CrossRefPubMedGoogle Scholar
  3. 3.
    Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P, Stalmeier PF, ten Kate FJ, van Dekken H, Obertop H, Tilanus HW, van Lanschot JJ (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347(21):1662–1669. CrossRefPubMedGoogle Scholar
  4. 4.
    van Heijl M, van Lanschot JJ, Blom RL, Bergman JJ, ten Kate FJ, Busch OR, Reitsma JB, Obertop H, van Berge Henegouwen MI (2010) Outcomes of 16 years of oesophageal surgery: low postoperative mortality and improved long-term survival. Nederlands tijdschrift voor geneeskunde 154:A1156PubMedGoogle Scholar
  5. 5.
    Capra S, Ferguson M, Ried K (2001) Cancer: impact of nutrition intervention outcome—nutrition issues for patients. Nutrition (Burbank, Los Angeles County, Calif) 17(9):769–772. CrossRefGoogle Scholar
  6. 6.
    Martin L, Lagergren J, Lindblad M, Rouvelas I, Lagergren P (2007) Malnutrition after oesophageal cancer surgery in Sweden. Br J Surg 94(12):1496–1500. CrossRefPubMedGoogle Scholar
  7. 7.
    Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, McNaught CE, MacFie J, Liberman AS, Soop M, Hill A, Kennedy RH, Lobo DN, Fearon K, Ljungqvist O (2013) Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. World J Surg 37(2):259–284. CrossRefPubMedGoogle Scholar
  8. 8.
    Muller S, Zalunardo MP, Hubner M, Clavien PA, Demartines N (2009) A fast-track program reduces complications and length of hospital stay after open colonic surgery. Gastroenterology 136(3):842–847. CrossRefPubMedGoogle Scholar
  9. 9.
    Preston SR, Markar SR, Baker CR, Soon Y, Singh S, Low DE (2013) Impact of a multidisciplinary standardized clinical pathway on perioperative outcomes in patients with oesophageal cancer. Br J Surg 100(1):105–112. CrossRefPubMedGoogle Scholar
  10. 10.
    Hammond JS, Humphries S, Simson N, Scrimshaw H, Catton J, Gornall C, Maxwell-Armstrong C (2014) Adherence to enhanced recovery after surgery protocols across a high-volume gastrointestinal surgical service. Dig Surg 31(2):117–122. CrossRefPubMedGoogle Scholar
  11. 11.
    Findlay JM, Gillies RS, Millo J, Sgromo B, Marshall RE, Maynard ND (2014) Enhanced recovery for esophagectomy: a systematic review and evidence-based guidelines. Ann Surg 259(3):413–431. CrossRefPubMedGoogle Scholar
  12. 12.
    Munitiz V, Martinez-de-Haro LF, Ortiz A, Ruiz-de-Angulo D, Pastor P, Parrilla P (2010) Effectiveness of a written clinical pathway for enhanced recovery after transthoracic (Ivor Lewis) oesophagectomy. Br J Surg 97(5):714–718. CrossRefPubMedGoogle Scholar
  13. 13.
    Weimann A, Braga M, Harsanyi L, Laviano A, Ljungqvist O, Soeters P, Jauch KW, Kemen M, Hiesmayr JM, Horbach T, Kuse ER, Vestweber KH (2006) ESPEN Guidelines on Enteral Nutrition: Surgery including organ transplantation. Clin Nutr 25(2):224–244. CrossRefPubMedGoogle Scholar
  14. 14.
    Lewis S, Andersen H, Thomas S (2009) Early enteral nutrition within 24 h of intestinal surgery versus later commencement of feeding: a systematic review and meta-analysis. J Gastrointest Surg 13(3):569–575. CrossRefPubMedGoogle Scholar
  15. 15.
    Isenring EA, Capra S, Bauer JD (2004) Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area. Br J Cancer 91(3):447–452. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Isenring E, Zabel R, Bannister M, Brown T, Findlay M, Kiss N, Loeliger J, Johnstone C, Camilleri B, Davidson W, Hill J, Bauer J (2013) Updated evidence-based practice guidelines for the nutritional management of patients receiving radiation therapy and/or chemotherapy. Nutrition Dietetics 70(4):312–324. CrossRefGoogle Scholar
  17. 17.
    Ottery FD (1996) Definition of standardized nutritional assessment and interventional pathways in oncology. Nutrition (Burbank, Los Angeles County, Calif) 12(1 Suppl):S15–S19. CrossRefGoogle Scholar
  18. 18.
    Gupta V (2009) Benefits versus risks: a prospective audit. Feeding jejunostomy during esophagectomy. World J Surg 33(7):1432–1438. CrossRefPubMedGoogle Scholar
  19. 19.
    Findlay JM, Tustian E, Millo J, Klucniks A, Sgromo B, Marshall RE, Gillies RS, Middleton MR, Maynard ND (2015) The effect of formalizing enhanced recovery after esophagectomy with a protocol. Dis Esophagus 28(6):567–573. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Katie Benton
    • 1
    Email author
  • Iain Thomson
    • 2
  • Elisabeth Isenring
    • 1
    • 3
  • B. Mark Smithers
    • 2
  • Ekta Agarwal
    • 1
    • 3
  1. 1.Department of Nutrition and Dietetics, Princess Alexandra HospitalWoolloongabbaAustralia
  2. 2.Discipline of Surgery, Upper GI and Soft Tissue Unit, Princess Alexandra HospitalUniversity of QueenslandWoolloongabbaAustralia
  3. 3.Faculty of Health Sciences and MedicineBond UniversityRobinaAustralia

Personalised recommendations