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 .
Pre-operative inspiratory muscle training preserves postoperative inspiratory muscle strength following major abdominal surgery - a randomised pilot study.
INTRODUCTION The aim of this pilot study was to assess the effect of pre-operative inspiratory muscle training ( IMT ) on respiratory variables in patients undergoing major abdominal surgery . PATIENTS AND METHODS Respiratory muscle strength ( maximum inspiratory [ MIP ] and expiratory [ MEP ] mouth pressure ) and pulmonary functions were measured at least 2 weeks before surgery in 80 patients awaiting major abdominal surgery . Patients were then allocated r and omly to one of four groups ( Group A , control ; Group B , deep breathing exercises ; Group C , incentive spirometry ; Group D , specific IMT ) . Patients in groups B , C and D were asked to train twice daily , each session lasting 15 min , for at least 2 weeks up to the day before surgery . Outcome measurements were made immediately pre-operatively and postoperatively . RESULTS In groups A , B and C , MIP did not increase from baseline to pre-operative assessment s. In group D , MIP increased from 51.5 cmH(2)O ( median ) pre-training to 68.5 cmH(2)O ( median ) post-training pre-operatively ( P < 0.01 ) . Postoperatively , groups A , B and C showed a fall in MIP from baseline ( P < 0.01 , P < 0.01 ) and P = 0.06 , respectively ) . No such significant reduction in postoperative MIP was seen in group D ( P = 0.36 ) . CONCLUSIONS Pre-operative specific IMT improves MIP pre-operatively and preserves it postoperatively . Further studies are required to establish if this is associated with reduced pulmonary complications
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 .