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 .
The effectiveness of preemptive analgesia varies according to the type of surgery: a randomized, double-blind study.
UNLABELLED The reliability of preemptive analgesia is controversial . Its effectiveness may vary among anatomical areas or surgical types . We evaluated preemptive analgesia by epidural morphine in six surgery types in a r and omized , double-blind manner . Pain intensity was rated using a visual analog scale , a verbal report , and a measurement of postsurgical morphine consumption .  Preemptive analgesia  was effective in limb surgery and mastectomy , but ineffective for gastrectomy , hysterectomy , herniorrhaphy , and appendectomy . Relief of postsurgical pain in hemiorrhaphy was more rapid than that in the other surgery types .  Preemptive analgesia  was effective in limb surgery and mastectomy , but not in surgeries involving laparotomy , regardless of whether the surgery was major ( gastrectomy and hysterectomy ) or minor ( herniorrhaphy and appendectomy ) . These results suggest that viscero-peritoneal nociception is involved in postsurgical pain . The abdominal viscera and peritoneum are innervated both heterosegmentally ( in duplicate or triplicate by the vagus and /or phrenic nerves ) and segmentally ( by the spinal nerves ) . Therefore , supraspinal and /or cervical spinal neurons might be sensitized , despite the blockade of the segmental nerves with epidural morphine . The rapid retreat of the pain after hemiorrhaphy suggests that central sensitization remits soon after minor surgery , but that in appendicitis , it may be protracted by additional noxious stimuli , such as infection . IMPLICATION S Epidural preemptive analgesia was reliably effective in limb and breast surgeries but ineffective in abdominal surgery , suggesting involvement of the brainstem and cervical spinal cord via the vagus and phlenic nerves
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 .