Overall , there is little direct evidence for components of ERAS , with much derived from nonesophageal thoracoabdominal surgery .
ERAS in principle seems logical and safe for esophagectomy .
OBJECTIVE This article aims to provide the first systematic review of enhanced recovery after surgery ( ERAS ) programs for  esophagectomy  and generate guidelines .
BACKGROUND ERAS programs use multimodal approaches to reduce complications and accelerate recovery .
Although ERAS is well established in colorectal surgery , experience after esophagectomy has been minimal .
However , esophagectomy remains an extremely high-risk operation , commonly performed in patients with significant comorbidities .
Consequently , ERAS may have a significant role to play in improving outcomes .
No guidelines or review s have been published in esophagectomy .
Epoetin alfa improves survival after chemoradiation for stage III esophageal cancer: final results of a prospective observational study.
PURPOSE This prospect i ve , nonr and omized study evaluates the effectiveness of epoetin alfa to maintain the hemoglobin levels at 12 to 14 g/dL ( optimal range for tumor oxygenation ) during chemoradiation for Stage III esophageal cancer and its impact on overall survival ( OS ) , metastatic-free survival ( MFS ) , and locoregional control ( LC ) . METHODS AND MATERIAL S Ninety-six patients were included . Forty-two patients received epoetin alfa ( 150 IU/kg , 3 times a week ) during radiotherapy , which was started at hemoglobin less than 13 g/dL and stopped at 14 g/dL or higher .  Hemoglobin levels were measured weekly during RT . RESULTS Both groups were balanced for age , sex , performance status , tumor length/location , histology , grading , T-stage/N-stage , chemotherapy , treatment schedule , and hemoglobin before RT . Median change of hemoglobin was + 0.3 g/dL/wk with epoetin alfa and -0.5 g/dL/wk without epoetin alfa . At least 60 % of hemoglobin levels were 12 to 14 g/dL in 64 % and 17 % of the patients , respectively ( p < 0.001 ) . Patients who received epoetin alfa had better OS ( 32 % vs. 8 % at 2 years , p = 0.009 ) and LC ( 67 % vs. 15 % at 2 years , p = 0.001 ) . MFS was not significantly different ( 42 % vs. 18 % at 2 years , p = 0.09 ) . CONCLUSIONS The findings suggest that epoetin alfa when used to maintain the hemoglobin levels at 12 to 14 g/dL can improve OS and LC of Stage III esophageal cancer patients
Overall , there is little direct evidence for components of ERAS , with much derived from nonesophageal thoracoabdominal surgery .
ERAS in principle seems logical and safe for esophagectomy .
OBJECTIVE This article aims to provide the first systematic review of enhanced recovery after surgery ( ERAS ) programs for  esophagectomy  and generate guidelines .
BACKGROUND ERAS programs use multimodal approaches to reduce complications and accelerate recovery .
Although ERAS is well established in colorectal surgery , experience after esophagectomy has been minimal .
However , esophagectomy remains an extremely high-risk operation , commonly performed in patients with significant comorbidities .
Consequently , ERAS may have a significant role to play in improving outcomes .
No guidelines or review s have been published in esophagectomy .