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 .
Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial
BACKGROUND Surgical resection is regarded as the only curative option for resectable oesophageal cancer , but pulmonary complications occurring in more than half of patients after open oesophagectomy are a great concern . We assessed whether minimally invasive oesophagectomy reduces morbidity compared with open oesophagectomy . METHODS We did a multicentre , open-label , r and omised controlled trial at five study centres in three countries between June 1 , 2009 , and March 31 , 2011 . Patients aged 18 - 75 years with resectable cancer of the oesophagus or gastro-oesophageal junction were r and omly assigned via a computer-generated r and omisation sequence to receive either open transthoracic or minimally invasive transthoracic oesophagectomy . R and omisation was stratified by centre . Patients , and investigators undertaking interventions , assessing outcomes , and analysing data , were not masked to group assignment . The primary outcome was pulmonary infection within the first 2 weeks after surgery and during the whole stay in hospital . Analysis was by intention to treat . This trial is registered with the Netherl and s Trial Register , NTR TC 2452 . FINDINGS We r and omly assigned 56 patients to the open oesophagectomy group and 59 to the minimally invasive oesophagectomy group . 16 ( 29 % ) patients in the open oesophagectomy group had pulmonary infection in the first 2 weeks compared with five ( 9 % ) in the minimally invasive group ( relative risk [ RR ] 0·30 , 95 % CI 0·12 - 0·76 ; p=0·005 ) . 19 ( 34 % ) patients in the open oesophagectomy group had pulmonary infection in-hospital compared with seven ( 12 % ) in the minimally invasive group ( 0·35 , 0·16 - 0·78 ; p=0·005 ) . For in-hospital mortality , one patient in the open oesophagectomy group died from anastomotic leakage and two in the minimally invasive group from aspiration and mediastinitis after anastomotic leakage . INTERPRETATION These findings provide evidence for the short-term benefits of minimally invasive oesophagectomy for patients with resectable oesophageal cancer . FUNDING Digestive Surgery Foundation of the Unit of Digestive Surgery of the VU University Medical Centre
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 .