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 impact of chest tube removal on pain and pulmonary function after pulmonary resection.
OBJECTIVE The aim of this study was to assess the immediate influence of chest tube removal on chest pain and forced expiratory volume in 1 s ( FEV1 )  after pulmonary resection . METHODS Prospect i ve longitudinal investigation on 104 consecutive patients ( 53 wedge/segmentectomies and 51 lobectomies ; 69 muscle and nerve-sparing lateral thoracotomy and 35 video-assisted thoracoscopic surgery ( VATS ) ) . Post-operative chest pain was controlled in all patients by a st and ardized combination of oral and intravenous non-opioid analgesics .  All patients had one chest tube ( 24 French ) .  Static and dynamic ( after forced expiratory effort ) pain and FEV1 were assessed before and 1 h after the chest tube removal by the same operator . No additional analgesics were administered before or after the chest tube removal . The pain level was assessed by the numeric pain scale [ range : 0 ( no pain)-10 ( excruciating pain ) ] . FEV1 was assessed by a portable spirometer . Bronchodilators were not used in these patients . Pre- and post-removal measurements were compared by the Wilcoxon signed rank test . RESULTS The average pre-removal static and dynamic pain scores were 2.6 and 4.1 , respectively . The static and dynamic pain scores decreased by 42 and 41 % , respectively , after the tube removal ( P < 0.0001 ) . The average FEV1 before the chest tube removal was 1.5 l or 53 % of the predicted value and increased by 13 % after the tube removal ( P = 0.0004 ) . In total , 56 and 78 % of patients reported static and dynamic pain scores improvement and 67 % showed an FEV1 improvement after the chest tube removal . Similar results were observed in patients operated on through VATS or thoracotomy . Compared with patients whose chest tube was removed later , those who had their chest tube removed before post operative day 3 ( POD3 ) , showed a greater reduction in the static pain score ( 41 vs. 31 % , P = 0.05 ) and greater improvement in FEV1 ( 18 vs. 0.01 % , P = 0.02 ) . CONCLUSIONS The removal of a chest tube reduces pain and improves ventilatory function , independent of surgical access and particularly in the early post-operative phase . A fast track chest tube removal policy may favour patients ' recovery
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 .