title: Enhanced recovery after surgery protocol in oesophageal cancer surgery: Systematic review and meta-analysis.
abstract: BACKGROUND
  Enhanced Recovery After Surgery (ERAS) protocol are well established in many surgical disciplines, leading to decrease in morbidity and length of hospital stay. These multi-modal protocols have been also introduced to oesophageal cancer surgery. This review aimed to evaluate current literature on ERAS in oesophageal cancer surgery and conduct a meta-analysis on primary and secondary outcomes.
  
  
  METHODS
  MEDLINE, Embase, Scopus and Cochrane Library were searched for eligible studies. We analyzed data up to May 2016. Eligible studies had to contain four described ERAS protocol elements. The primary outcome was overall morbidity. Secondary outcomes included length of hospital stay, specific complications, mortality and readmissions. Random effect meta-analyses were undertaken.
  
  
  RESULTS
  Initial search yielded 1,064 articles. Thorough evaluation resulted in 13 eligible articles which were analyzed. A total of 2,042 patients were included in the analysis (1,058 ERAS group and 984 treated with traditional protocols). Analysis of overall morbidity as well as complication rate did not show any significant reduction. Non-surgical complications and pulmonary complications were significantly lower in the ERAS group, RR = 0.71 95% CI 0.62-0.80, p < 0.00001 and RR = 0.75, 95% CI 0.60-0.94, p = 0.01, respectively. Meta-analysis on length of stay presented significant reduction Mean difference = -3.55, 95% CI -4.41 to -2.69, p for effect<0.00001.
  
  
  CONCLUSIONS
  This systematic review with a meta-analysis on ERAS in oesophageal surgery indicates a reduction of non-surgical complications and no negative influence on overall morbidity. Moreover, a reduction in the length of hospital stay was presented.
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.|Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kraków, Poland.|Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Pisarska
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.|Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kraków, Poland.|Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Małczak
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.|Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kraków, Poland.|Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Major
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.|Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kraków, Poland.|Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Wysocki
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.|Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kraków, Poland.|Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Budzyński
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.|Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kraków, Poland.|Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland.
authors.forename: Michał
authors.identifier: http://orcid.org/0000-0001-9073-2667
authors.initials: M
authors.lastname: Pędziwiatr
mesh_terms: D004938:Esophageal Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D020127:Recovery of Function; D000078202:Systematic Reviews as Topic; D016896:Treatment Outcome