Optimizing Postoperative Recovery in Colorectal Surgery: A Systematic Review on the Efficacy of Enhanced Recovery After Surgery (ERAS) Protocols

Colorectal surgery carries substantial risks of postoperative morbidity, extended hospital stays, and increased healthcare costs. While the overall benefits of enhanced recovery after surgery (ERAS) protocols are well established, recent studies have expanded their scope to include immunological outcomes, telemedicine integration, and patient-centered recovery metrics. This systematic review synthesizes the latest evidence from randomized controlled trials (RCTs) evaluating ERAS protocols in colorectal surgery, with particular attention to these emerging dimensions. A comprehensive search of PubMed, Scopus, Web of Science, Embase, and ClinicalTrials up to July 2025 identified 10 eligible RCTs from 414 screened records. Risk of bias was assessed using the Cochrane RoB 2 tool. Narrative synthesis was performed due to heterogeneity in ERAS components and outcome definitions. Consistent with prior literature, ERAS accelerated the return of bowel function, reduced the length of hospital stay, and lowered complication rates. Notably, recent trials demonstrated immunological benefits, including reductions in inflammatory markers (IL-6, CRP [C-reactive protein]) and preservation of immune function. Telemedicine-enhanced ERAS pathways, such as remote postoperative monitoring, further shortened recovery times while maintaining high patient satisfaction. Patient-centered outcomes, including functional independence, quality of life, and readiness for home discharge, were significantly improved. Most studies exhibited low risk of bias, although variability in ERAS implementation and reporting persisted. These findings confirm that contemporary ERAS protocols not only optimize physiological recovery but also address immune resilience, leverage digital health tools, and prioritize patient experience. Future research should standardize implementation and assess the long-term effects of these innovations.