Enhanced recovery after surgery in gynecologic surgery: perspectives and controversies from the 2026 ERAS World Congress
In brief
Gynecologic ERAS moves from blanket protocols to precision, patient-selected pathways
At the 2026 ERAS World Congress, experts debated which components of enhanced recovery pathways add real value, the feasibility of opioid-free surgery, prehabilitation benefits, and early feeding risks, while also exploring AI support, trial standards, home environment impact, and equity gaps worldwide. The discussions signal a shift toward precision peri-operative care focused on patient selection and implementation science, but substantial uncertainties remain, outlining a roadmap for future research.
- Journal
- International journal of gynecological cancer : official journal of the International Gynecological Cancer Society (Q1)
- Published
- 22 June 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Teresa Lucia Pan, Paula Mateo-Kubach, Arthur Heng-Cheng Hsu, Kamilla L David, Helena M Obermair, Stephanie Gill, et al.
- PMID
- 42447683
- DOI
- 10.1016/j.ijgc.2026.104822
Why clinicians should know about it
- Picked for Obstetrics and Gynecology (top studies of the week, 19 July 2026).
Abstract
Enhanced recovery after surgery pathways have transformed perioperative care in gynecologic surgery, yet important questions remain regarding the value of individual pathway components, optimal implementation strategies, and the direction of future innovation. The Obstetrics and Gynecology Symposium at the 12th Enhanced Recovery After Surgery World Congress (Singapore, May 2026) convened international experts to debate the most contested and rapidly evolving topics in the field. This article summarizes the principal arguments and perspectives presented across three sessions. Session I examined the evidence base for current enhanced recovery after surgery practice through rapid-fire debates on four topics: the identification of low-value pathway components, the feasibility of opioid-free perioperative recovery, the evidence for structured prehabilitation, and the risks of universal early post-operative feeding. Session II addressed future directions through structured pro/con debates on whether artificial intelligence can replace enhanced recovery after surgery coordinators, whether randomized controlled trials should be the required standard for enhanced recovery after surgery evidence, and whether the home environment is a primary determinant of post-operative recovery. Session III broadened the perspective to global enhanced recovery after surgery, addressing racial and ethnic disparities in surgical outcomes, implementation opportunities in low- and middle-income countries, and key updates in the 2026 Enhanced Recovery After Surgery Society Gynecologic Oncology Guidelines. Collectively, these discussions underscored a shift from broad implementation toward precision perioperative care, with increasing emphasis on patient selection, implementation science, equity, and technological innovation. While consensus is emerging in some areas, substantial uncertainties remain. The debates presented at the congress establish a scholarly framework for future research and the continued evolution of enhanced recovery after surgery in gynecologic surgery.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.