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 .
When to remove a chest tube? A randomized study with subsequent prospective consecutive validation.
BACKGROUND Operative procedures on the pleural space are usually managed by chest tube drainage . Timing for removing the tube is empirically established , with wide variation among surgeons . Our objective was to evaluate the effectiveness and safety of establishing a volume of 200 mL/d of uninfected drainage as a threshold for removal of chest tube , as compared with more frequently used volumes of 100 and 150 mL/d . STUDY DESIGN A prospect i ve r and omized study was performed in a single institution . Patients ( n = 139 ) su bmi tting to pleural drainage after surgical procedures were r and omized to one of three groups , defined by the planned timing of chest tube removal ( depending on the threshold volume per day of pleural fluid drained ) : G-100 ( < or = 100 mL/d , n = 44 ) ; G-150 ( < or = 150 mL/d , n = 58 ) ; and G-200 ( < or = 200 mL/d , n = 37 ) . Subsequently , another 91 consecutive patients had chest tubes removed when drainage was less than 200 mL/d ( G-val , prospect i ve validation group ) . All patients had similar discharge and 60-day followup .  Drainage time , hospital stay , and reaccumulation rate were registered . RESULTS Drainage time ( median days : 3.5 for G-100 , 3 for G-150 , 3 for G-200 , 3 for G-val ) and hospital stay ( median days : 4 for G-100 , 3 for G-150 , 3 for G-200 , 3 for G-val ) were not statistically different among groups . Radiologic reaccumulation rates were 9.1 % for G-100 , 13.1 % for G-150 , 5.4 % for G-200 , and 10.9 % for G-val , and the thoracenteses rates were 2.3 % , 0.8 % , 2.7 % , and 3.3 % , respectively , with no major differences among groups ( G-100 versus G-150 versus G-200 ; G-200 versus G-val ) . CONCLUSIONS Increasing the threshold of daily drainage to 200 mL before removing the chest tube did not markedly affect drainage , hospitalization time , or overall costs , nor did it increase the likelihood of major pleural fluid reaccumulation . This volume ( 200 mL/d ) could be recommended for chest tube withdrawal decision for uninfected pleural fluid with no evidence of air leaks
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 .