A pattern of consistent evolution in fast-track protocol s was clearly demonstrated and these have shown variations in the core-identified components across the studies .
In the future incremental gains through focused improvements in key components will lend itself to even better postoperative outcomes and patient experience during oesophageal cancer treatment
Fast track is a st and ardised goal directed patient 's care pathway that aims to facilitate recovery following surgery .
Currently , there are large variations in the fast track protocol s used in oesophagectomy due to the complexity of the procedure .
The objective of this systematic review is to assess the evolution of fast track protocol s  following oesophagectomy  since its implementation and the result ing effect on postoperative outcomes .
Robot-assisted minimally invasive thoraco-laparoscopic esophagectomy versus open transthoracic esophagectomy for resectable esophageal cancer, a randomized controlled trial (ROBOT trial)
Background For esophageal cancer patients , radical esophagolymphadenectomy is the cornerstone of multimodality treatment with curative intent . Transthoracic esophagectomy is the preferred surgical approach worldwide allowing for en-bloc resection of the tumor with the surrounding lymph nodes . However , the percentage of cardiopulmonary complications associated with the transthoracic approach is high ( 50 to 70%).Recent studies have shown that robot-assisted minimally invasive thoraco-laparoscopic esophagectomy ( RATE ) is at least equivalent to the open transthoracic approach for esophageal cancer in terms of short-term oncological outcomes . RATE was accompanied with reduced blood loss , shorter ICU stay and improved lymph node retrieval compared with open esophagectomy , and the pulmonary complication rate , hospital stay and perioperative mortality were comparable . The objective is to evaluate the efficacy , risks , quality of life and cost-effectiveness of RATE as an alternative to open transthoracic esophagectomy for treatment of esophageal cancer . Methods / design This is an investigator-initiated and investigator-driven monocenter r and omized controlled parallel-group , superiority trial . All adult patients ( age ≥18 and ≤80 years ) with histologically proven , surgically resectable ( cT1 - 4a , N0 - 3 , M0 ) esophageal carcinoma of the intrathoracic esophagus and with European Clinical Oncology Group performance status 0 , 1 or 2 will be assessed for eligibility and included after obtaining informed consent . Patients ( n = 112 ) with resectable esophageal cancer are r and omized in the outpatient department to either RATE ( n = 56 ) or open three-stage transthoracic esophageal resection ( n = 56 ) . The primary outcome of this study is the percentage of overall complications ( grade 2 and higher ) as stated by the modified Clavien – Dindo classification of surgical complications . Discussion This is the first r and omized controlled trial design ed to compare RATE with open transthoracic esophagectomy as surgical treatment for resectable esophageal cancer . If our hypothesis is proven correct , RATE will result in a lower percentage of postoperative complications , lower blood loss , and shorter hospital stay , but with at least similar oncologic outcomes and better postoperative quality of life compared with open transthoracic esophagectomy . The study started in January 2012 . Follow-up will be 5 years . Short-term results will be analyzed and published after discharge of the last r and omized patient . Trial registration Dutch trial register : NTR3291 Clinical Trial.gov :
A pattern of consistent evolution in fast-track protocol s was clearly demonstrated and these have shown variations in the core-identified components across the studies .
In the future incremental gains through focused improvements in key components will lend itself to even better postoperative outcomes and patient experience during oesophageal cancer treatment
Fast track is a st and ardised goal directed patient 's care pathway that aims to facilitate recovery following surgery .
Currently , there are large variations in the fast track protocol s used in oesophagectomy due to the complexity of the procedure .
The objective of this systematic review is to assess the evolution of fast track protocol s  following oesophagectomy  since its implementation and the result ing effect on postoperative outcomes .