A pattern of consistent evolution in fast-track protocol s was clearly demonstrated and these have shown variations in the core-identified components across the studies .
In the future incremental gains through focused improvements in key components will lend itself to even better postoperative outcomes and patient experience during oesophageal cancer treatment
Fast track is a st and ardised goal directed patient 's care pathway that aims to facilitate recovery following surgery .
Currently , there are large variations in the fast track protocol s used in oesophagectomy due to the complexity of the procedure .
The objective of this systematic review is to assess the evolution of fast track protocol s  following oesophagectomy  since its implementation and the result ing effect on postoperative outcomes .
Short and Long-Term Outcomes of Epidural or Intravenous Analgesia after Esophagectomy: A Propensity-Matched Cohort Study
Background and Objectives As a well-established technique for postoperative pain relief , the benefits of epidural analgesia ( EDA ) have been under debate recently . This study aim ed to determine whether EDA could improve perioperative outcomes and survival in patients undergoing esophagectomy . Methods From January 2010 to December 2012 , 587 consecutive cases undergoing McKeown-type esohpageactomy  were retrospectively identified from a prospect ively maintained data base . Results After propensity-matching , incorporating baseline characteristics , 178 cases were included in each group , and patients characteristics distributions were well-balanced between two groups . Compared with intravenous analgesia , the use of EDA significantly decreased the incidence of pneumonia from 32 % to 19.7 % ( P = 0.008 ) , and anastomotic leakage from 23.0 % to 14.0 % ( P = 0.029 ) . The change in CRP level of EDA group was significantly decreased ( preoperative , 6.2 vs. 6.2 ; POD 1 , 108.1 vs. 121.3 ; POD 3 , 131.5 vs. 137.8 ; POD 7 , 69.3 vs. 82.1 mg/L ; P = 0.044 ) . EDA patients had a significantly longer duration of indwelling urinary catheter ( P<0.001 ) , and lower levels in both systolic ( P = 0.001 ) and diastolic blood pressure ( P<0.001 ) . There were n't significant differences in overall survival ( log-rank P = 0.47 ) and recurrence ( Gray-test P = 0.46 ) between two groups . Conclusions These findings revealed that EDA could attenuate inflammatory response and reduce the incidence of pneumonia and anastomotic leakage after esophagectomy , at the price of delayed urinary catheter removal and lower blood pressure . EDA remains an important component of multimodal perioperative management after esophagectomy
A pattern of consistent evolution in fast-track protocol s was clearly demonstrated and these have shown variations in the core-identified components across the studies .
In the future incremental gains through focused improvements in key components will lend itself to even better postoperative outcomes and patient experience during oesophageal cancer treatment
Fast track is a st and ardised goal directed patient 's care pathway that aims to facilitate recovery following surgery .
Currently , there are large variations in the fast track protocol s used in oesophagectomy due to the complexity of the procedure .
The objective of this systematic review is to assess the evolution of fast track protocol s  following oesophagectomy  since its implementation and the result ing effect on postoperative outcomes .