The Latest Results and Future Direction of Research for Enhanced Recovery After Surgery in the Field of Colorectal Surgery

Abstract

Enhanced recovery after surgery (ERAS) aims to promote postoperative recovery of patients by minimizing surgical stress response through the evidence-based multimodal intervention. In 2023, the clinical practice guidelines were updated in the North America, with the existing most recent guidelines announced at the ERAS society in 2019. This review compares and reviews these two guidelines to examine ERAS principles and items related to colorectal surgery and to introduce the latest relevant study results published within five years. In the pre-hospitalization stage, the concept of pre-hospitalization is emphasized to check and reinforce the nutritional status and physical functional status before surgery. In the preoperative stage, as a result of the accumulation of large-scale studies, there was a change in the recommendation of mechanical bowl preparation combined with oral antibiotics in color electronic surgery. In the intraoperative stage, laparoscopic surgery became popular and became an important component of ERAS, where more technologically advanced single-incision laparoscopic surgery and robotic surgery were the subject of active research. Ileus-prevention items such as opioid-sparing multimodal pain management and euvolemic fluid therapy are recommended in the postoperative stage. The advancement of ERAS is leading to the accumulation of researches on the "same-day discharge". ERAS is expanding into various surgeries, situations, institutions, and societies. In order to maximize the effect by increasing the compliance of ERAS, medical staff must fully understand the clinical basis and meaning of each items, and the protocol must be maintained and developed steadily through team approaches and audit system.