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 .
Fast-track surgery improves postoperative clinical recovery and reduces postoperative insulin resistance after esophagectomy for esophageal cancer
Purpose This study aims to investigate the influence of fast-track surgery ( FTS ) on insulin resistance indicators in a prospect i ve r and omized , controlled clinical trial in esophageal cancer patients . Methods Between November 2009 and March 2011 , 34 patients underwent the FTS pathway , and 34 patients underwent the conventional pathway after esophagectomy in our department . The times to postoperative flatus and defecation , duration of postoperative hospital stay , hospitalization expenditures , and postoperative complications were recorded . Insulin resistance indicators were measured before operation as well as on the 1st , 3rd , and 7th postoperative days ( PODs ) , including serum levels of fasting blood glucose ( FBG ) , fasting insulin ( FINS ) , interleukin-6 ( IL-6 ) , and C-reactive protein ( CRP ) in patients of both groups . The insulin resistance index ( homeostasis model assessment of insulin resistance ( HOMA-IR ) ) was calculated at each time point . Results We found a significantly shorter postoperative hospital stay and faster return of gastrointestinal function in patients who underwent  FTS  ( P < 0.01 ) . In addition , the total hospitalization expenditure was significantly lower in the FTS group ( P < 0.01 ) . The preoperative insulin resistance indicators showed no significant differences between the two groups . On PODs 1 and 3 , the levels of log-HOMA-IR , FINS , IL-6 , and CRP in the FTS group were significantly lower than those in the control group ( all P < 0.05 ) . On POD 7 , the CRP level in the FTS group was significantly lower than that in the control group ( P < 0.05 ) . Conclusions FTS promotes early recovery of gastrointestinal function and reduces stress reaction and postoperative insulin resistance after esophagectomy for esophageal cancer
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 .