{"entity":{"id":"eras-perioperative-nutrition","kind":"technology","name":"Enhanced recovery (ERAS) and perioperative nutrition","aka":[],"tldr":"Instead of starving patients before and after an operation, modern surgical pathways feed them early, give carbohydrate drinks the night before, and get them walking the next day. Complications and hospital stays fall.","summary":"ERAS protocols bundle 20-plus evidence-based elements: no prolonged fasting, pre-operative carbohydrate loading, avoidance of routine nasogastric tubes and drains, early oral feeding, multimodal opioid-sparing analgesia and early mobilisation. Meta-analyses across colorectal, gastric, pancreatic and oesophageal surgery show 30-50% fewer complications and a two- to three-day shorter stay, with no increase in readmissions. Nutrition is the thread running through the bundle; malnourished patients (weight loss over 10%, low albumin) benefit from 7-14 days of pre-operative nutritional support, and this is the doorway through which prehabilitation entered surgical care.","status":"standard-of-care","asOf":"2026-09-08","links":[{"label":"ERAS Society guidelines","url":"https://erassociety.org/guidelines/"},{"label":"NICE NG151: colorectal cancer, recommendations","url":"https://www.nice.org.uk/guidance/ng151/chapter/Recommendations"},{"label":"Bowel Cancer UK: prehabilitation, preparing for treatment","url":"https://www.bowelcanceruk.org.uk/about-bowel-cancer/treatment/prehabilitation/"}],"tags":[],"related":[],"cancers":["colorectal","gastric","pancreatic","esophageal","urothelial"],"sections":["nutrition-lifestyle","surgery","supportive-care","rejuvenation"],"technologies":["prehabilitation","oncology-nutrition","robotic-surgery"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["prehabilitation-term","malnutrition-screening"],"trials":["prehab-trial"],"people":[],"bottlenecks":["b-surgery-radiation-innovation","b-care-fragmentation"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":["Bowel cancer: NICE NG151 says that if recovery protocols such as enhanced recovery after surgery are used, teams should explain to people what these involve and their value in improving recovery after surgery, and defines them as perioperative care pathways designed to promote early recovery by optimising health before surgery and maintaining health and functioning after it."],"principle":"Minimising the catabolic stress response to surgery through nutritional, anaesthetic and physiological measures preserves gut function and lean mass and shortens recovery.","strengths":["Large and consistent effect on complications and stay","Low cost; mostly removing harmful habits","Guidelines exist for every major cancer operation"],"limitations":["Compliance with all elements is often below 70%","Effect on long-term oncological outcomes indirect","Requires whole-team culture change"],"since":2001},"route":"/technologies/eras-perioperative-nutrition/","neighbours":{"cancer":[{"id":"urothelial","kind":"cancer","name":"Bladder & urothelial cancer","route":"/cancers/urothelial/"},{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"gastric","kind":"cancer","name":"Gastric & gastro-oesophageal junction cancer","route":"/cancers/gastric/"},{"id":"lung-cancer","kind":"cancer","name":"Lung cancer (all types)","route":"/cancers/lung-cancer/"},{"id":"esophageal","kind":"cancer","name":"Oesophageal cancer","route":"/cancers/esophageal/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"},{"id":"resectable-pdac","kind":"cancer","name":"Resectable pancreatic ductal adenocarcinoma","route":"/cancers/resectable-pdac/"}],"section":[{"id":"nutrition-lifestyle","kind":"section","name":"Diet, Exercise & Lifestyle","route":"/fronts/nutrition-lifestyle/"},{"id":"rejuvenation","kind":"section","name":"Recovery & Rejuvenation","route":"/fronts/rejuvenation/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"},{"id":"surgery","kind":"section","name":"Surgery & Interventional","route":"/fronts/surgery/"}],"technology":[{"id":"ct-body-composition-sarcopenia","kind":"technology","name":"CT body composition and sarcopenia measurement","route":"/technologies/ct-body-composition-sarcopenia/"},{"id":"immunonutrition-perioperative","kind":"technology","name":"Immunonutrition before cancer surgery","route":"/technologies/immunonutrition-perioperative/"},{"id":"oncology-nutrition","kind":"technology","name":"Nutrition support and cachexia management","route":"/technologies/oncology-nutrition/"},{"id":"prehabilitation","kind":"technology","name":"Prehabilitation before cancer surgery","route":"/technologies/prehabilitation/"},{"id":"robotic-surgery","kind":"technology","name":"Robotic & minimally invasive surgery","route":"/technologies/robotic-surgery/"},{"id":"rejuv-rehab-prehabilitation-programme","kind":"technology","name":"What a prehabilitation programme actually contains, and how long it needs","route":"/technologies/rejuv-rehab-prehabilitation-programme/"},{"id":"rejuv-rehab-prehabilitation-evidence","kind":"technology","name":"What the randomised trials of prehabilitation found, operation by operation","route":"/technologies/rejuv-rehab-prehabilitation-evidence/"}],"term":[{"id":"immunonutrition","kind":"term","name":"Immunonutrition","route":"/terms/immunonutrition/"},{"id":"malnutrition-screening","kind":"term","name":"Malnutrition screening tools (MUST, NRS-2002, MST, PG-SGA)","route":"/terms/malnutrition-screening/"},{"id":"prehabilitation-term","kind":"term","name":"Prehabilitation (the pre-treatment window)","route":"/terms/prehabilitation-term/"},{"id":"surgical-morbidity","kind":"term","name":"Surgical morbidity and postoperative complications","route":"/terms/surgical-morbidity/"}],"trial":[{"id":"prehab-trial","kind":"trial","name":"PREHAB: multimodal prehabilitation before colorectal cancer surgery","route":"/trials/prehab-trial/"}],"bottleneck":[{"id":"b-care-fragmentation","kind":"bottleneck","name":"Fragmented care and guideline gaps","route":"/bottlenecks/b-care-fragmentation/"},{"id":"b-surgery-radiation-innovation","kind":"bottleneck","name":"Surgery and radiotherapy cure most, get least","route":"/bottlenecks/b-surgery-radiation-innovation/"}],"idea":[{"id":"idea-nl-dietitian-in-every-mdt","kind":"idea","name":"A dietitian in every gastrointestinal and head and neck tumour board","route":"/ideas/idea-nl-dietitian-in-every-mdt/"}],"roadmap":[{"id":"nutrition-lifestyle-roadmap","kind":"roadmap","name":"Diet, exercise and lifestyle roadmap: causes established → interventions that disappointed → exercise proven as treatment","route":"/roadmaps/nutrition-lifestyle-roadmap/"},{"id":"surgery-roadmap","kind":"roadmap","name":"Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work","route":"/roadmaps/surgery-roadmap/"}]}}