Enhanced Recovery After Surgery in Oesophagogastric Procedures: A Systematic Review of Clinical Outcomes and Postoperative Recovery

Enhanced Recovery After Surgery (ERAS) programmes have revolutionised perioperative care by integrating evidence-based, multimodal strategies aimed at minimising surgical stress, accelerating recovery, and reducing postoperative morbidity. This systematic review evaluates the impact of ERAS implementation on postoperative morbidity and length of hospital stay (LOS) in patients undergoing oesophagogastric surgery. A comprehensive literature search was conducted across major databases, including PubMed/MEDLINE, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL), identifying randomised controlled trials (RCTs) published between January 2019 and September 2024. Seven high-quality RCTs involving oesophagectomy and gastrectomy were included for qualitative synthesis. Collectively, these studies demonstrated that ERAS significantly reduced complication rates, particularly pulmonary and gastrointestinal complications, while consistently shortening LOS compared with conventional perioperative care. Some trials further indicated additional benefits such as improved immune modulation, earlier initiation of adjuvant therapy, and enhanced long-term survival outcomes. Mechanistically, ERAS protocols mitigated the physiological stress response, promoted early gastrointestinal motility, and optimised pain control without compromising safety. Despite variations in compliance and protocol standardisation, the evidence supports ERAS as a safe and effective framework for improving short- and long-term postoperative outcomes in upper gastrointestinal surgery. Future studies should focus on personalised ERAS models, compliance auditing, and digital integration to enhance protocol adaptability across diverse healthcare systems.