Introduction: Esophageal cancer surgery presents significant postoperative challenges, including hemodynamic instability and anastomosis leaks, which adversely affect patient outcomes. The Enhanced Recovery After Surgery (ERAS®) protocol has been developed to optimize perioperative care, aiming to enhance recovery, improve hemodynamic stability, and reduce complications. This study evaluates the effect of ERAS® on hemodynamic stability and the incidence of anastomosis leaks in patients undergoing esophageal cancer surgery.

Materials and Methods: A prospective, observational study was conducted from 2018 to 2023. Adult patients undergoing elective esophageal cancer surgery were divided into two groups: those managed under the ERAS® protocol (ERAS group) and those receiving standard care (Control group). The ERAS® protocol included preoperative counseling, carbohydrate loading, nutritional optimization, early mobilization, multimodal analgesia, and reduced opioid use. Primary outcomes were hemodynamic stability (mean arterial pressure, heart rate variability) and anastomosis leak rates. Results: The incidence of anastomotic leaks was significantly lower in the ERAS® group compared to the standard care group (7% vs. 15%, p=0.035). Patients in the ERAS® group also had a shorter time to detection and resolution of leaks, as well as fewer complications related to leaks. Postoperative hemodynamic stability was also better in the ERAS® group, with fewer patients requiring prolonged vasopressor support (10% vs. 22%, p=0.027). Conclusion: The ERAS® protocol significantly improves hemodynamic stability and reduces the incidence of anastomosis leaks in esophageal cancer surgery. These findings support the implementation of ERAS® protocols to enhance surgical outcomes and patient recovery. Further research is warranted to confirm these results in larger, multi-center trials and to explore additional benefits of ERAS® in diverse patient populations.