In 2019, the high stakes world of esophageal surgery in Belgium took a bold step toward consistency. The importance of this type of surgery was clear to everyone in the field which dealt with the management and successful carrying out of the operation. What changed when these centers of surgical excellence were centralised?

The process of performing esophagectomy for cancer was significant, as it left high chances of disease recurring in patients and complications. It is also risky for the patient and the hospital itself due to a greater potential for post-operative complications. One has to keep in mind that it also is a procedure that requires a high level of expertise. A centralized approach was implemented which made the process easier for the medical professionals and for the patients. Surgical performance was at the forefront of all these changes because it directly affects the patient. On the other hand, changes were made to improving the outcomes for these patients after the surgery.

Surgeons started following a specific set of rules called perioperative protocols which are a set of rules and guidelines that are approved globally by other medical professionals. There were rules that were adapted nationally. The guidelines were introduced specifically for esophagectomy, ensuring that specific measures were taken to make these policies standard.

The use of these protocols meant tracking and measuring a lot of outcomes. In Belgium, the overall performance is not perfect, but it is definitely not bad. Which specific standards does this approach meet? The measurement of the effectiveness of the treatment are important and are as follows: a patient's duration of stay, pneumonia and leaks from procedure, and mortality rates. All of these measurements were taken into account.

The precise figures from Belgium speak volumes: an average of 20 measures and the survival rate for the operation- a 12-day hospital stay. It was found that the mortality rate was just over 3% after 30 days to 7% after 90 days. The guidelines and protocols were followed by everyone.

The average score on the ERAS checklist, according to Belgian surgeons, was 15. 5 out of 20. The centralization of esophagectomies in Belgium isn't perfect, but it is far from a failure. There are apparent gaps in the uniformity and adherence to these protocols across the nation, so patient care isnt fair and equal everywhere.

The ERAS game plan

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