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Enhanced Recovery After Surgery (ERAS) in Elderly Patients Undergoing Upper Gastrointestinal Surgery: Current Evidence and Future Perspectives

Year: 2026

Type: article

Abstract: Background/Objectives: Enhanced Recovery After Surgery (ERAS) has substantially advanced perioperative care across multiple surgical disciplines. Research in colorectal surgery has clearly demonstrated the effectiveness of ERAS programs; however, evidence regarding the application of these protocols in elderly patients undergoing upper gastrointestinal (GI) surgery remains limited. This population has a high prevalence of multimorbidity, frailty, and diminished physiological reserve, factors that collectively increase vulnerability to postoperative complications and may influence adherence to ERAS pathways. Methods: This narrative review is based on a structured literature search of PubMed, Scopus, and Web of Science for studies published between 2000 and 2025. The search identified randomized controlled trials (RCTs), observational studies, meta-analyses, and clinical guidelines evaluating ERAS protocols in elderly patients undergoing upper GI surgery. Results: Available evidence indicates that ERAS protocols are feasible and safe in elderly patients undergoing upper GI surgery, including gastrectomy and esophagectomy. Studies consistently associate their implementation with shorter hospital stays, faster gastrointestinal recovery, and no significant increase in postoperative complications or readmission rates. However, heterogeneity in study designs, ERAS components, and definitions of ‘elderly’ limits comparability across studies. Conclusions: ERAS protocols represent a promising perioperative strategy for elderly patients undergoing upper GI surgery. When implemented within a multidisciplinary framework and tailored to patients’ frailty and comorbidities, these protocols may improve postoperative recovery while maintaining safety. Future research should prioritize multicenter RCTs to identify the most effective ERAS components and evaluate long-term clinical and functional outcomes in this population.

Source: Surgeries

DOI: 10.3390/surgeries7030100

Authors: Giuseppe Palomba, Marianna Capuano, Alessandra Lucia Simeone, Emanuele Alfonso Campitiello, Giovanni Aprea

Institutions: Federico II University Hospital, University of Naples Federico II

Language: English

Topic: Enhanced Recovery After Surgery

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,448