title: Enhanced recovery for esophagectomy: a systematic review and evidence-based guidelines.
abstract: 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 reviews have been published in esophagectomy.
  
  
  METHODS
  We undertook a systematic review of the PubMed, EMBASE, and the Cochrane databases in July 2012. The literature was searched for descriptions of ERAS in esophagectomy. Components of successful ERAS programs were determined, and when not directly available for esophagectomy, extrapolation from related evidence was made. Graded recommendations for each component were then generated.
  
  
  RESULTS
  Six retrospective studies have assessed ERAS for esophagectomy, demonstrating favorable morbidity, mortality, and length of stay. Methodological quality is, however, low. Overall, there is little direct evidence for components of ERAS, with much derived from nonesophageal thoracoabdominal surgery.
  
  
  CONCLUSIONS
  ERAS in principle seems logical and safe for esophagectomy. However, the underlying evidence is poor and lacking. Despite this, a number of recommendations for practice and research can be made.
authors.affiliation: *Oxford OesophagoGastric Centre, Churchill Hospital; and †Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, United Kingdom.
authors.forename: John M
authors.initials: JM
authors.lastname: Findlay
authors.forename: Richard S
authors.initials: RS
authors.lastname: Gillies
authors.forename: Julian
authors.initials: J
authors.lastname: Millo
authors.forename: Bruno
authors.initials: B
authors.lastname: Sgromo
authors.forename: Robert E K
authors.initials: RE
authors.lastname: Marshall
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Maynard
mesh_terms: D004935:Esophageal Diseases / Q000601:surgery*; D016629:Esophagectomy; D019317:Evidence-Based Medicine; D006801:Humans; D011182:Postoperative Care / Q000379:methods*; D017410:Practice Guidelines as Topic; D020127:Recovery of Function