World Journal of Surgery

, Volume 43, Issue 2, pp 299–330 | Cite as

Guidelines for Perioperative Care in Esophagectomy: Enhanced Recovery After Surgery (ERAS®) Society Recommendations

  • Donald E. LowEmail author
  • William Allum
  • Giovanni De Manzoni
  • Lorenzo Ferri
  • Arul Immanuel
  • MadhanKumar Kuppusamy
  • Simon Law
  • Mats Lindblad
  • Nick Maynard
  • Joseph Neal
  • C. S. Pramesh
  • Mike Scott
  • B. Mark Smithers
  • Valérie Addor
  • Olle Ljungqvist
Scientific Review



Enhanced recovery after surgery (ERAS) programs provide a format for multidisciplinary care and has been shown to predictably improve short term outcomes associated with surgical procedures. Esophagectomy has historically been associated with significant levels of morbidity and mortality and as a result routine application and audit of ERAS guidelines specifically designed for esophageal resection has significant potential to improve outcomes associated with this complex procedure.


A team of international experts in the surgical management of esophageal cancer was assembled and the existing literature was identified and reviewed prior to the production of the guidelines. Well established procedure specific components of ERAS were reviewed and updated with changes relevant to esophagectomy. Procedure specific, operative and technical sections were produced utilizing the best current level of evidence. All sections were rated regarding the level of evidence and overall recommendation according to the evaluation (GRADE) system.


Thirty-nine sections were ultimately produced and assessed for quality of evidence and recommendations. Some sections were completely new to ERAS programs due to the fact that esophagectomy is the first guideline with a thoracic component to the procedure.


The current ERAS society guidelines should be reviewed and applied in all centers looking to improve outcomes and quality associated with esophageal resection.


Compliance with ethical standards

Conflict of interest

Dr. Allum reports other from Nestle, and personal fees from Lilly, outside the submitted work. Dr. Ljungqvist reports other from Encare AB, personal fees from Nutricia, NL, during the conduct of the study; other from Encare AB (Sweden), personal fees and other from Nutricia (NL), outside the submitted work. Dr. Neal reports other from American Society of Regional Anesthesia and Pain Medicine, other from Hospital for Special Surgery, New York, NY, personal fees from Virginia Mason Medical Center, personal fees from Occasional expert medical consultation, grants from Washington State Society of Anesthesiologists, and personal fees from Wolters Kluwer, outside the submitted work. Dr. Scott reports personal fees from Merck, personal fees from Deltex, and personal fees from Edwards, outside the submitted work. The authors Drs. Low, De Manzoni, Ferri, Immanuel, Kuppusamy, Law, Lindblad, Maynard, Pramesh, Smithers, and Addor have nothing to disclose.


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Donald E. Low
    • 1
    Email author
  • William Allum
    • 2
  • Giovanni De Manzoni
    • 3
  • Lorenzo Ferri
    • 4
  • Arul Immanuel
    • 5
  • MadhanKumar Kuppusamy
    • 1
  • Simon Law
    • 6
  • Mats Lindblad
    • 7
  • Nick Maynard
    • 8
  • Joseph Neal
    • 1
  • C. S. Pramesh
    • 9
  • Mike Scott
    • 10
  • B. Mark Smithers
    • 11
  • Valérie Addor
    • 12
  • Olle Ljungqvist
    • 13
  1. 1.Head of Thoracic Surgery and Thoracic Oncology, C6-GSVirginia Mason Medical CenterSeattleUSA
  2. 2.The Royal Marsden HospitalsLondonUK
  3. 3.University of VeronaVeronaItaly
  4. 4.McGill University Health CentreMontrealCanada
  5. 5.Newcastle upon Tyne HospitalsNewcastle upon TyneUK
  6. 6.Queen Mary HospitalHong KongChina
  7. 7.Karolinska InstitutetStockholmSweden
  8. 8.Oxford Radcliffe HospitalsOxfordUK
  9. 9.Tata Memorial CentreMumbaiIndia
  10. 10.Virginia Commonwealth University Health SystemRichmondUSA
  11. 11.Princess Alexandra HospitalThe University of QueenslandBrisbaneAustralia
  12. 12.Centre Hospitalier Universitaire VaudoisLausanneSwitzerland
  13. 13.Örebro UniversityÖrebroSweden

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