The results of esophagectomy with simultaneous esophagoplasty within the framework of the RAPOR program. Single-center experience of treating 500 patients

BACKGROUND: Esophagectomy (EE) with simultaneous esophagoplasty is a high risk intervention accompanied by the high rate of complications (up to 74%) and hospital mortality (up to 10% in the high-flow centers). For improving the results of treating the surgery patients, the Enhanced Recovery After Surgery (ERAS) society has issued the recommendations on the perioperative management of patients. Based on the ERAS elements, we have compiled a flexible program for rational accelerated perioperative rehabilitation (RAPOR) based on the individual, team-based and interdisciplinary approach. AIM: to evaluate the treatment results in the patients after the esophagectomy with simultaneous esophagoplasty within the frameworks of the RAPOR program. METHODS: a single-center non-randomized retrospective research was arranged. Within the premises of the National Medical Research Center of Surgery named after A.V. Vishenvsky (NMRCS), during the period of 2012–2024, 500 scheduled primary EE were performed with simultaneous esophagoplasty due to the presence of the benign (54%) and the malignant (46%) diseases of the esophagus. The median age was 59 years. With this, 12.8% of the patients were older than 70 years. The median BMI was 23.5 kg/m2, but in 5.6% of the patients it was lower than 17 kg/m2. The median ASA was grade 3, while ASA grade 4 was reported in 8.6% of the patients. The pre-operative preparation was carried out in 27.8% of the patients. A total of 21.8% had a correction of nutritional insufficiency, 7% — correction of the cardiovascular diseases. Based on the analysis of case history data, further evaluation included the mortality, the rate and the severity of post-operative complications using the Esophagectomy Complications Consensus Group (ECCG) score. RESULTS: post-operative complications were observed in 29.2% of the patients. The more often diagnosed complications were the pulmonary ones (22.4%). Pneumonia was found in 10% of the patients. The gastro-intestinal complications were verified in 7.8% of the patients. Of them, the subtotal necrosis of the transplant was developing in 11 (2.2%) patients, the apical necrosis of the transplant and the esophageal anastomosis failure were reported in 11 (2.2%) and 11 (2.2%) respectively. The infectious complications were observed in 9.6% of the patients, urological — in 7%, cardial — in 6.2%, thromboembolic — in 3%, neurological — in 6.6%, wound-related — in 1.4% and other types — in 4.8% of the patients. The post-operative chylothorax was developing in 0.2% of the cases. The complications with grade III-b and higher according to the Clavien-Dindo classification were observed in 10.8% of the patients. The post-operative mortality was 1.4%. CONCLUSION: the implementation of the RAPOR program into the practice of the NMRCS has allowed for expanding the operability margins due to the addition of the aged and the comorbid patients, moving away from the criteria for selecting the patients towards the detection of the risk factors and their correction.