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 .
Thoracic epidural analgesia or intravenous morphine analgesia after thoracoabdominal esophagectomy: a prospective follow-up of 201 patients.
OBJECTIVE Thoracoabdominal esophagectomy is a major surgical procedure that carries significant postoperative morbidity and mortality . Because the choice of analgesic technique may influence outcome , the impact of thoracic epidural or intravenous analgesia was investigated after esophagectomy . DESIGN Prospect i ve observational study during January 1996 until January 2002 . SETTING University hospital . PARTICIPANTS All patients undergoing thoracoabdominal esophagectomy during the 6-year period . INTERVENTIONS Patients were prospect ively monitored during a 6-year period . Duration of surgery , intraoperative blood loss , fluid administration , postoperative intubation time , intensive care unit ( ICU ) stay , pain relief and related side effects , postoperative complications , hospital stay , and in-hospital and long-term mortality were compared in relation with the analgesic technique . MEASUREMENTS AND MAIN RESULT Thoracic epidural analgesia with bupivacaine/morphine was used in 166 patients , and intravenous morphine analgesia was used in 35 patients .  Postoperative intubation time and ICU stay were similar in both groups . Patients with epidural analgesia experienced less pain . Sedation , respiratory depression , hallucinations , and confusion were more common in the intravenous morphine group . Postoperative weight did not differ between the groups , despite fluid replacement that was higher in the epidural group during the first 24 hours . The in-hospital mortality rate was 0.5 % . CONCLUSIONS No differences in morbidity/mortality rates depending on analgesic treatment were observed in patients undergoing thoracoabdominal esophagectomy . Thoracic epidural analgesia provided better pain relief with fewer opioid-related side effects than intravenous morphine analgesia . However , postoperative epidural analgesia was associated with more technical difficulties
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 .