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 .
Focused preoperative patient stoma education, prior to ileostomy formation after anterior resection, contributes to a reduction in delayed discharge within the enhanced recovery programme
Purpose Stoma formation is a well-known cause for delayed discharge  following colorectal surgery . This has been addressed by the enhanced recovery programme ( ERP ) preoperatively through stoma counselling sessions . These aim to promote independent stoma management post-operatively , thus expediting hospital discharge . We compared the numbers of patients with prolonged hospital stay secondary to delayed independent stoma management prior to and following the introduction of an enhanced recovery programme with preoperative stoma education . Methods Data collection on patients undergoing anterior resection with the formation of a loop ileostomy was carried out retrospectively prior to ERP ( January 2006 to August 2008 ) and prospect ively following the introduction of  ERP  ( September 2008 to October 2010 ) . Comparisons were made in patients with prolonged hospital stay ( defined as hospital stay of more than 5 days ) secondary to stoma management . Results Two hundred forty patients underwent elective anterior resection with the formation of a loop ileostomy , 120 prior ERP  and 120 post-ERP . Average length of hospital stay was 14 days before ERP introduction , with a range of 7–25 days . The mean length of stay amongst the ERP patients was 8 days ( p = 0.17 ) , ranging from 3 to 17 days . Twenty-one patients in the pre-ERP group ( 17.5 % ) experienced postponed hospital discharge due to a delay in independent stoma management , compared to one patient experiencing such a delay after the introduction of ERP ( 0.8 % , p < 0.0001 ) . Conclusions Delayed discharge secondary to independent stoma management can be significantly reduced with preoperative stoma management teaching as part of an enhanced recovery programme
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 .