# Enhanced recovery after lung cancer surgery (ERAS pathway for lung resection)

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

## TL;DR

Enhanced recovery for lung cancer surgery means stopping smoking and getting fitter beforehand, keyhole surgery where possible, a short fast with a sugary drink, nerve blocks for pain, no routine stomach tube and an early catheter removal, drinking a few hours after the operation, getting up within a day, and physiotherapy.

## Summary

The ERAS Society and ESTS guideline (2019; 45 items) is the specialty standard; only its abstract could be read, which lists key recommendations without grades: counselling, nutritional screening, smoking cessation, prehabilitation for high-risk patients, avoiding fasting, carbohydrate loading, no sedative premedication, VTE prophylaxis, warming, short-acting anaesthetics, regional anaesthesia, nausea control, opioid-sparing analgesia, euvolaemia, minimally invasive surgery, early chest drain removal, avoiding urinary catheters and early mobilisation. The graded detail here is from the Italian PACTS consensus (2020, USPSTF grades), read in full: VATS whenever possible (good, A); smoking cessation ideally 4 weeks before (fair, A); prehabilitation (poor, A); fasting 2 hours for clear fluids and 6 for solids (good, A) and carbohydrate loading (poor, A); no routine benzodiazepines (fair, B); temperature of at least 36 °C (good, A); balanced crystalloid (good, A) and near-zero fluid balance (fair, A); protective one-lung ventilation (fair, A); risk-based nausea prophylaxis (good, A); no routine nasogastric tube and early catheter removal (fair, A); locoregional analgesia with paravertebral block for VATS (good, A) and epidural for thoracotomy or high risk (fair, A); IV NSAIDs (good, A); no suction on drains without complications (good, D); oral intake 4 to 6 hours after surgery (fair, A); mobilisation within 24 hours and physiotherapy (fair, A).

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: ERAS thoracic; ERAS lung resection; enhanced recovery lobectomy; fast-track thoracic surgery; perioperative care for lung cancer surgery

## 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/), [Routine tests before planned surgery, by size of operation and fitness](https://onco.cc/protocols/routine-preoperative-tests/), [Surgical site infection prevention: skin preparation, antibiotic timing, warming and wound care](https://onco.cc/protocols/surgical-site-infection-prevention/)
- cancers: [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/)
- technologies: [Enhanced recovery (ERAS) and perioperative nutrition](https://onco.cc/technologies/eras-perioperative-nutrition/), [Prehabilitation before cancer surgery](https://onco.cc/technologies/prehabilitation/)
- terms: [Lobectomy](https://onco.cc/terms/lobectomy/), [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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