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 .
Feasibility and effectiveness of pre-operative inspiratory muscle training in patients undergoing oesophagectomy: a pilot study.
BACKGROUND Patients undergoing oesophageal surgery have a high risk for post-operative complications including pulmonary infections . Recently , physical therapy has shifted from the post-operative to the pre-operative phase to diminish post-operative complications and to shorten hospital stay . The purpose of this pilot study was to investigate the feasibility and initial effectiveness of pre-operative inspiratory muscle training ( IMT ) on the incidence of pneumonia in patients undergoing oesophagectomy . METHODS A pragmatic non-r and omized controlled trial was conducted among all patients who underwent an oesophagectomy between January 2009 and February 2010 . Patients in the intervention group received IMT prior to surgery . Feasibility was assessed on the basis of the occurrence of adverse effects during testing or training and patient satisfaction . Initial effectiveness on respiratory function was evaluated by maximal inspiratory pressure ( MIP ) and endurance , the incidence of post-operative pneumonia and length of hospital stay . RESULTS Eighty-three patients were included , of which 44 received pre-operative IMT . No adverse effects were observed .  IMT was well tolerated and appreciated . In the intervention group , the median MIP and endurance improved significantly after IMT by 32 % and 41 % , respectively ( p < 0.001 ) . The incidence of post-operative pneumonia and the length of hospital stay were comparable for the intervention and the conventional care groups ( pneumonia , 25 % vs. 23 % [ p = 0.84 ] ; hospitalization , 13.5 vs. 12 days [ p = 0.08 ] ) . CONCLUSIONS Pre-operative IMT is feasible in patients with oesophageal carcinoma and significantly improves respiratory muscle function . This , however , did not result in a reduction of post-operative pneumonia in patients undergoing oesophagectomy
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 .