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 .
Esophagectomy—It’s Not Just About Mortality Anymore: Standardized Perioperative Clinical Pathways Improve Outcomes in Patients with Esophageal Cancer
Background Esophageal resection ( ER ) remains the st and ard therapy for early esophageal cancer ; however , because of concerns regarding high levels of morbidity and mortality reported in analyses of national data bases , many patients are relegated to less effective endoscopic or chemotherapeutic approaches . Methods All patients undergoing esophagectomy by a single surgeon for cancer or high- grade dysplasia between 05/91–05/06 were prospect ively entered into an IRB-approved data base . All aspects of work-up and treatment were guided by an evolving st and ardized perioperative clinical pathway . Results Three hundred forty consecutive patients , mean age of 64 ( 33–90 ) , underwent ER for Barrett ’s esophagus ( 17 ) or invasive cancer stages I-87 , II-133 , III-94 , IV-9 . One hundred thirty-nine ( 41 % ) had neoadjuvant therapy .  Sixty-three percent were American Society of Anesthesiologists class III or IV , and five different operative approaches were used . Patient were managed intraoperatively with a “ fluid restriction ” protocol . Mean intraoperative blood loss was 230 cc . 99.5 % of patients were extubated immediately , and mean ICU and hospital stays were 2.25 ( 1–30 ) and 11.5 ( 6–49 ) days , respectively . Postoperative analgesia was managed with patient-controlled epidural analgesia in 98.5 % , and 86 % were mobilized on day 1 after surgery . Complications occurred in 153 patients ( 45 % ) , most commonly atrial dysrhythmia ( 13 % ) , and postoperative delirium ( 11 % ) . Anastomotic leaks occurred in 13 patients ( 3.8 % ) . Mortality occurred in one patient ( 0.3 % ) . No significant differences were seen in length of stay , operative time , blood loss , or complications in patients receiving neoadjuvant therapy . For stages I , II , and III , patients between 1998–2004 Kaplan – Meier 5-year cumulative survival was 92.4 , 57.1 , and 34.5 % , respectively . Conclusions Surgical treatment of esophageal cancer can be done with moderate morbidity and very low mortality , and the expectation of improved levels of survival , especially in early-stage patients . St and ardized perioperative clinical pathways can provide the infrastructure for the treatment of these patients and should include increased efforts to minimize blood loss and transfusions , improve postoperative pain control and extubation rates , and facilitate early mobilization and discharge . ER , as sole therapy or in combination with radiation/chemotherapy , should remain the st and ard of care in patients with early and locoregional esophageal cancer
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 .