99 Background: We have performed perioperative management using modified ERAS protocol after esophageal cancer surgery. Our protocol includes plaque control in collaboration with dental clinic, breathing training, nutrition support for low-nutrition, preoperative oral rehydration, pain control, early mobilization, early enteral nutrition and intestinal peristalsis monitoring by abdominal Xp with contrast agents after surgery, and so on. Methods: The aim of the study is to clarify the safety of our modified ERAS protocol as perioperative management of esohphageal surgery. 136 cases of thoracic esophageal cancer patients were performed with 3 field lymph node dissection between January 2011 and July 2014 using modified ERAS protocol(group A). 29 cases were performed classical postoperative management between September 2008 and November 2009(group B). We compared ventilator weaning dates, start dates of postoperative ambulation, start dates of enteral feeding, start dates of oral intake, length of hospital stay, the number of hospital death between group A and group B. Results: In group A, except two cases was extubated in POD1, start dates of postoperative ambulation was POD1(median), start dates of enteral feeding was POD1(median), start dates of oral intake was POD6(median), length of hospital stay was 15days(median), and the number of hospital death was 1case. On the other hand, in group B, dates of extubation was POD4(median), start dates of postoperative ambulation was POD2(median), enteral feeding was not sued for postoperative management, start dates of oral intake was POD15(median), length of hospital stay was 29days(median), and the number of hospital death was 2case. After introduction of this protocol, all these values were significantly reduced in group A rather than in group B. Walking distance were 130m(POD1), 322m(POD2), 509m(POD3), completion rate of enteral feeding was 90%, and the safety of enteral nutrition was also confirmed by peristalsis monitor using abdominal Xp with contrast agents or defecation state. Conclusions: It was considered that perioperative management of esophageal cancer surgery based on modified ERAS protocol is contribute to the early recover of postoperative status.