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 .
Nutritional Status as a Risk Factor in Esophageal Surgery
Background : Nutritional condition is one of the factors determining postoperative outcome in esophageal surgery . This study explored the relation between preoperative nutritional status and postoperative infectious complications . Methods : From a prospect i ve data base , 400 patients who underwent esophageal resection for malignancy were selected .  Preoperative nutritional status was assessed by body mass index , prognostic nutritional index ( PNI ) , nutritional risk index ( NRI ) and weight loss . The association between nutritional parameters and postoperative complications and mortality , gender , age and hospitalization was assessed . Results : PNI and NRI differed between the patients with and without postoperative infectious complications ( p = 0.031 and p = 0.009 , respectively ) . However , receiver operating characteristic curves showed that PNI and NRI have a low predictive value for such complications . Also , no associations were found between nutritional parameters and in-hospital mortality . Although mean nutritional parameters were significantly lower , i.e. worse , in patients with neoadjuvant treatment as compared to no such treatment , the incidence of complications did not significantly differ between these treatment groups . Although PNI and NRI correlated negatively with age , no association was found between age and infectious complications . Multivariate analysis of various factors showed the male gender to be the only significant risk factor for development of infectious complications . Discussion : Preoperative nutritional status established by PNI , NRI , body mass index and weight loss has limited value in predicting complications following esophageal resection
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 .