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 .
Pain relief after esophagectomy: Thoracic epidural analgesia is better than parenteral opioids.
OBJECTIVE To compare postoperative pain relief and pulmonary function in patients after thoracoabdominal esophagectomy treated by continuing perioperative thoracic epidural anesthesia or changing to parenteral  opioids . DESIGN Prospect i ve , r and omized study . SETTING University teaching hospital . PARTICIPANTS Thirty-three patients undergoing thoracoabdominal esophagectomy . INTERVENTIONS General anesthesia was combined with thoracic epidural anesthesia during surgery . The patients either continued with thoracic epidural analgesia ( n = 18 ) or were switched to patient-controlled analgesia with intravenous morphine ( n = 15 ) for 5 postoperative days .  Pain scores were estimated twice daily , at rest and after mobilization . Peak expiratory flow , forced expiratory volume , and vital capacity were measured the day before surgery , postoperative day 2 , and postoperative day 6 . Adverse events and complications were recorded . MEASUREMENTS AND MAIN RESULTS At rest , there were no differences in pain relief between the groups . Pain scores at mobilization showed a significantly lower value in the epidural group ( p < 0.027 ) . No intergroup differences were found regarding pulmonary function , which decreased on postoperative day 2 , but was improved on postoperative day 6 . CONCLUSION Continuation of intraoperative thoracic epidural anesthesia for 5 postoperative days provides better pain relief at mobilization compared with a switch to patient-controlled analgesia with intravenous morphine . There was no intergroup difference in the impact on measures of pulmonary function
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 .