# Enhanced recovery after oesophagectomy (ERAS pathway for oesophageal cancer surgery)

Source: https://onco.cc/protocols/enhanced-recovery-after-oesophagectomy/  
OnCo record `enhanced-recovery-after-oesophagectomy` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Enhanced recovery is a package of care that helps people recover from removal of the oesophagus: dietitian support, getting fitter beforehand, treating low iron, a short fast, keyhole surgery where the team is trained in it, an epidural for pain, early tube or mouth feeding, getting out of bed early, removing tubes once no longer needed, and four weeks of clot prevention.

## Summary

The ERAS Society guideline for esophagectomy (2019; 39 items, each graded by GRADE) is the current specialty standard; its full text could not be read here, so its oesophagectomy-specific items are taken from the summary table in Halliday and Moorthy (Ann Surg Oncol 2022), which does not print grades. Items: nutrition assessment and treatment by individual risk with no routine immunonutrition; oral iron for iron-deficiency anaemia; multimodal prehabilitation; surgery 3 to 6 weeks after neoadjuvant chemotherapy or 6 to 10 weeks after neoadjuvant radiotherapy; no routine bowel preparation; solids until 6 hours (with caution in dysphagia) and clear fluids until 2 hours before; minimally invasive surgery where there is training and expertise; gastric conduit first line; nasogastric decompression of the conduit (unlike most ERAS pathways, which avoid routine nasogastric tubes); a single chest drain; balanced crystalloid; lung-protective ventilation; core temperature above 36 °C; level of postoperative care set by individual risk; thoracic epidural first line with paravertebral block as an alternative; early enteral feeding reaching full calories by day 3 to 6 by jejunostomy or nasojejunal tube; mobilisation from the day of surgery if feasible; chest drain removal below 200 ml a day without air or chyle leak; avoiding positive fluid balance; glucose below 10 mmol/l; and VTE prophylaxis for 4 weeks. Elements associated with a shorter stay in a meta-analysis cited there include immediate extubation, mobilisation by day 1, urinary catheter out by day 2 and oral fluids by day 1. NICE NG83 (2018) offers specialist dietetic support before, during and after radical treatment, and immediate enteral or parenteral nutrition after surgery.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: ERAS oesophagectomy; ERAS esophagectomy; enhanced recovery esophagectomy; fast-track oesophagectomy; perioperative care for oesophagectomy

## Connected records

- protocols: [Blood clot prevention around cancer surgery, including extended prophylaxis after major abdominal and pelvic operations](https://onco.cc/protocols/vte-prophylaxis-after-cancer-surgery/), [Enhanced recovery after liver surgery (ERAS pathway for hepatectomy)](https://onco.cc/protocols/enhanced-recovery-after-liver-surgery/), [Surgical site infection prevention: skin preparation, antibiotic timing, warming and wound care](https://onco.cc/protocols/surgical-site-infection-prevention/)
- cancers: [Oesophageal and junctional adenocarcinoma](https://onco.cc/cancers/oesophageal-adenocarcinoma/), [Oesophageal cancer](https://onco.cc/cancers/esophageal/), [Oesophageal squamous cell carcinoma](https://onco.cc/cancers/oesophageal-squamous-cell-carcinoma/)
- technologies: [Enhanced recovery (ERAS) and perioperative nutrition](https://onco.cc/technologies/eras-perioperative-nutrition/), [Enteral and parenteral nutrition support](https://onco.cc/technologies/enteral-parenteral-nutrition/), [Prehabilitation before cancer surgery](https://onco.cc/technologies/prehabilitation/)
- terms: [Oesophagectomy](https://onco.cc/terms/oesophagectomy/), [Prehabilitation (the pre-treatment window)](https://onco.cc/terms/prehabilitation-term/)
- ideas: [Clear drinks until two hours before an operation, rather than nothing from midnight](https://onco.cc/ideas/idea-pu-shorter-fasting-before-surgery/), [Enhanced recovery after cancer surgery, with each element's compliance measured and fed back](https://onco.cc/ideas/idea-pu-enhanced-recovery-with-measured-compliance/)

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