# Enhanced recovery after gastrectomy (ERAS pathway for stomach cancer surgery)

Source: https://onco.cc/protocols/enhanced-recovery-after-gastrectomy/  
OnCo record `enhanced-recovery-after-gastrectomy` (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 stomach surgery: a dietitian's assessment and feeding support for anyone undernourished, keyhole surgery for early cancers where suitable, no routine nose tube or drain, drinking and eating from the day after surgery and building up slowly, extra feeding support if eating stays low, and checking that every step happens.

## Summary

The ERAS Society gastrectomy guideline (2014; 25 items, 8 procedure-specific, graded by GRADE) is the only ERAS gastrectomy edition. Its full text could not be read; its procedure-specific items and grades are quoted from the reproduction in Yamagata et al. (2019). Strong: no routine preoperative artificial nutrition, but optimise significantly malnourished patients with oral supplements or enteral nutrition (very low evidence); laparoscopy-assisted distal gastrectomy for early gastric cancer (high); no routine nasogastric or nasojejunal tube (high); avoid abdominal drains (high); individualised nutritional support for those clearly malnourished or unable to meet 60% of needs by day 6 (moderate); systematic audit (low). Weak: preoperative oral pharmaconutrition (insufficient evidence for gastrectomy), laparoscopy-assisted total gastrectomy, wound catheters and TAP block (no gastrectomy evidence), and drink and food at will from day 1 after total gastrectomy, increasing by tolerance (moderate). A 2025 meta-analysis of 27 randomised trials (3,274 patients) found ERAS shortened stay and sped bowel recovery without more complications or readmissions, with low to moderate certainty. NICE NG83 offers specialist dietetic support throughout radical treatment for oesophago-gastric cancer; NICE NG180 offers enhanced recovery for elective major surgery, clear fluids until 2 hours before, and suggests carbohydrate drinks for abdominal surgery. Japanese guidelines (2018) describe a slower model pathway.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: ERAS gastrectomy; enhanced recovery gastric cancer surgery; fast-track gastrectomy; perioperative care for gastrectomy

## 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: [Gastric & gastro-oesophageal junction cancer](https://onco.cc/cancers/gastric/)
- 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: [Gastrectomy](https://onco.cc/terms/gastrectomy/), [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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