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 .
Preoperative Epoetin Alfa in Colorectal Surgery: A Randomized, Controlled Study
Background Colorectal cancer patients are often anemic before surgery , and this leads to an increased requirement for allogeneic blood transfusion . This may result in transfusion-induced immunosuppression , which in turn leads to increased morbidity and possibly an increased rate of tumor relapse . We investigated the possible benefits of perioperative epoetin alfa administration in anemic patients to correct hemoglobin levels and reduce transfusion needs . Methods A total of 223 colorectal cancer patients with anemia scheduled for surgery were r and omized to a group that received epoetin alfa 150 or 300 IU/kg/day subcutaneously for 12 days ( day -10 to + 1 ) or to a control group . All received iron ( 200 mg/day by mouth ) for 10 days before surgery . Hemoglobin levels , hematocrit , and the number of blood units transfused were recorded . Results A total of 204 patients were eligible for analysis .  Mean hemoglobin levels and hematocrit were significantly higher in the 300 IU/kg group than in the control group , both 1 day before surgery ( hemoglobin , P = .008 ; hematocrit , P = .0005 ) and 1 day after surgery ( hemoglobin , P = .011 ; hematocrit , P = .0008 ) . Blood loss during and after surgery was similar in all groups . Patients who received epoetin alfa 300 IU/kg required significantly fewer perioperative transfusion units than control patients ( .81 vs. 1.32 ; P = .016 ) and significantly fewer postoperative units ( .87 vs. 1.33 ; P = .023 ) . There were no significant differences in the number of units in the 150 IU/kg group . Conclusions Preoperative epoetin alfa ( 300 IU/day ) increases hemoglobin levels and hematocrit in colorectal surgery patients . These effects are associated with a reduced need for perioperative and postoperative transfusions
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 .