Table 1. Fast-track protocol for patients undergoing robotic Ivor Lewis esophagectomy.

Day of surgery

Patient sent to floor

Nasogastric tube placed to suction

Monitor chest tube output and urinary outputs q4 h

Continuous monitoring of heart rhythm and pulse oximeter

POD1

Jejunal tube feedings at full concentration, starting at 20 mL/h

Ambulate patient four times per day; physical therapy every day

Chest tube to suction

Strict aspiration precautions; head of bed at 30°; nasogastric tube suction

POD2

Continue to ambulate patient a minimum of four times per day until discharge

Increase rate of jejunal tube feedings, 10 mL/4 h

Consult nutritional therapist

Continue aspiration precautions; physical therapy

Remove Foley catheter

POD3

Increase rate of jejunal tube feedings until achieving goal rate

Remove chest tube if no chyle and drainage <450 mL/d

Consult speech pathologist

Continue aspiration precautions; physical therapy

POD4

Gastrografin swallow (or on POD5 if POD4 is a Sunday)

Continue jejunal tube feeds

If swallow shows no leak, advance patient to a full liquid diet and skip clear liquids

Continue aspiration precautions; patient warned not to eat while drowsy or to lie recumbent within 3 h of eating

Continue physical therapy

Education on chewing and swallowing

POD5

Advance to soft diet as tolerated

Start compressing jejunal feedings by increasing rate and turning off for 4 h/d

Continue aspiration precautions; physical therapy

POD6

Nutrition education provided by dietician

Set up home jejunal tube feedings

Start to compress jejunal tube feedings 7 pm to 7 am

Continue aspiration precautions; physical therapy

POD7

Discharge home on soft diet with continued aspiration precautions and compressed tube feedings at night only

POD, postoperative day.