Table 4 Summary of included studies

Forsmo et al. (2016)

[18]

To compare the outcomes of patients undergoing elective colorectal resection with a multimodal ERAS approach emphasizing counseling against those receiving conventional standard care

Adult patients eligible for open or laparoscopic colorectal resection – randomized to an ERAS programme or standard care

Hospital Stay: ERAS patients had a shorter stay (median 5 days vs. median 8 days; P = 0.001).

Other outcomes: No differences in morbidity, reoperations, readmissions, or 30-day mortality.

Nutrition & Inflammation: Similar enteral nutrition tolerance and inflammatory response in both groups, as indicated by postoperative C-reactive protein levels.

Bednarski et al. (2019)

[19]

To assess if combining MIS, ERP, and a structured telemedicine program (TeleRecovery) could reduce the total 30-day LOS by 50%

English-speaking adult patients undergoing curative surgery for colon or rectal cancer - randomized into experimental and control groups.

The RecoverMI approach, integrating MIS, ERAS, and TeleRecovery, significantly reduced 30-day and index length of stay (LOS) after colorectal cancer resection (p < 0.05) compared to controls. While the control group’s 30-day LOS was just over 2 days, the RecoverMI group achieved a further reduction (p < 0.05). Postoperative pain scores were slightly higher in the RecoverMI arm, likely due to earlier discharge. There were no significant differences in readmissions or adverse events (p > 0.05)

Forsmo et al. (2016)

[23]

To evaluate the effectiveness of an ERAS program with specialized ERAS and stoma nurse specialists in reducing hospital stays, readmissions, stoma-related complications, and improving HRQoL compared to standard stoma education and care.

Adult patients set to undergo laparoscopic or open colorectal resection with a planned stoma - equally divided into 2 groups: ERAS program with extended stoma education and Standard care with current stoma education

Hospital stay: The ERAS group had a shorter stay (median 6 days) than standard care (median 9 days; p < 0.001).

Other outcomes: No significant differences between the two groups in terms of overall morbidity, readmission rates, HRQoL, stoma-related complications, or 30-day mortality.

Li et al. (2019)

[24]

To assess the clinical benefits of combining ERAS with laparoscopic techniques in radical colorectal cancer resection

Patients undergoing laparoscopic colorectal cancer surgery - divided equally into an ERAS group and a conventional care group

The ERAS group experienced notably shorter durations for first exhaust, first defecation, and extubation (all P < 0.05); Had a lower overall complication rate compared to the conventional group (P < 0.05); Showed significantly higher levels of albumin and total protein (both P < 0.05)

ElRahman et al. (2020)

[25]

To evaluate and compare the effectiveness of ERP versus conventional perioperative care in elective open surgery for left-sided colonic carcinoma, focusing on hospital stay and postoperative complications

Adults with stage I or II left-sided colon cancer and eligible for elective resection were equally divided into two groups: Conventional Care and ERP

Compared to conventional care, the enhanced recovery group had:

Significantly reduced pain (VAS: 3 vs. 4.6, P = 0.024)

Less postoperative nausea and vomiting (17.5% vs. 37.5%, P = 0.045)

Shorter hospital stay (5.4 vs. 7.6 days, P < 0.001)

Shetiwy et al.

(2017) [20]

To evaluate the effectiveness of ERAS protocols in comparison to conventional recovery care in colorectal cancer patients undergoing elective laparoscopic resection, with a focus on hospital stay, recovery of gastrointestinal function, postoperative complications, and readmission rates.

Adult patients with colorectal cancer scheduled for elective laparoscopic colorectal surgery were randomly assigned to 2 groups: A conventional recovery group (n = 35) and an enhanced recovery group (n = 35).

Hospital Stay: ERAS group had a significantly shorter stay (4.49 days) compared to the conventional group (13.31 days) (P < 0.001)

NGT Removal: ERAS group had faster removal of NGTs (0.77 days) compared to conventional care (3.26 days) (P < 0.001)

Enteral Feeding: ERAS patients achieved enteral feeding sooner (1.89 days) than the conventional group (5.46 days) (P < 0.001)

Drain Removal: Time to removal of intra-abdominal drains was significantly shorter in the ERAS group (2.94 days) versus conventional care (9.06 days) (P < 0.001)

Complications: Fewer complications were observed in the ERAS group (25.7%) compared to the conventional group (65.7%) (P = 0.001)

Readmission Rates: similar between both groups

Taupyk et al. (2015) [21]

To assess the effectiveness of FTS, a in improving recovery outcomes for colorectal cancer patients undergoing surgery.

Adult patients with colorectal cancer undergoing elective laparoscopic surgery were divided into 2 groups: 31 patients in the FTS group and 39 patients in the control group

Hospital Stay: FTS group (5.9 ± 0.8 days) vs. control group (10.9 ± 1.3 days), P < 0.05

Postoperative Stay: FTS group (4.3 ± 0.8 days) vs. control group (8.0 ± 1.1 days), P < 0.05

First Flatus Time: FTS group (1.6 ± 0.8 days) vs. control group (2.5 ± 0.9 days), P < 0.05

Defecation Time: FTS group (2.2 ± 0.7 days) vs. control group (4.5 ± 0.7 days), P < 0.05

CRP Levels: FTS group had lower postoperative CRP levels than control group, P < 0.05

Time to restoration of solid diet: FTS group (1.1 ± 0.3 days) vs. control group (3.6 ± 0.9 days), P < 0.05

Postoperative complications: No significant differences in between the groups

Mari et al. (2016) [26]

To compare immune and nutritional serum markers in patients undergoing elective colorectal laparoscopic surgery with an ERAS protocol versus standard care

Adult patients undergoing major colorectal laparoscopic surgery were randomized into two groups – an ERAS group and a standard care group with 70 patients in each

IL-6 levels: Lower in the ERAS group on postoperative days 1, 3, and 5 (P < 0.05); returned to preoperative levels by day 3 only in the ERAS group

CRP levels: Lower in the ERAS group on postoperative days 1, 3, and 5 (P < 0.05)

Cortisol and prolactin: No significant differences between groups

Prealbumin: Higher in the ERAS group on day 5 (P < 0.05)

First Flatus: Day 1.6 (ERAS) vs. 2.1 (Standard) (P < 0.05)

Solid Meal: Day 1.5 (ERAS) vs. 3 (Standard) (P < 0.05)

Discharge: Day 5 (ERAS) vs. 7.2 (Standard) (P < 0.05)

Feng et al. (2016) [27]

To study the effects of FTS on immunity and inflammation in colorectal surgery patients

Adult patients with histologically confirmed colorectal cancer scheduled for colorectal surgery were randomly divided into 2 groups – FTS group (116 patients) and traditional group (114 patients)

Inflammatory Markers: CRP, IL-6, and TNF-α were lower in the FTS group on POD 1, POD 4, and POD 6 (p < 0.05).

Immune Function: IgG, IgA, C3, and C4 levels were higher in the FTS group on POD 4 and POD 6 (p < 0.05).

Recovery Milestones: Time to first flatus, defecation, oral intake, and ambulation was shorter in the FTS group (p < 0.05).

Complications: FTS group had fewer total complications (p < 0.05).

Hospital Stay: No significant difference in postoperative hospital duration between groups (p > 0.05).

Ostermann et al. (2019) [22]

To determine the effectiveness and feasibility of ERP for elderly patients (≥ 70 years) undergoing elective colorectal surgery when compared to standard care

Elderly patients (70 years and older) planned for elective colorectal surgery were randomly assigned to either one of the 2 groups: ERP (75 patients) or standard care (75 patients)

Reduced postoperative morbidity: 47% reduction in morbidity (35% in ERP vs. 65% in standard care, p = 0.0003)

Total complications significantly lower in ERP group (54 vs. 118, p = 0.0003)

Fewer infectious complications in ERP group – reduced by 52% (13 vs. 29, p = 0.001)

No anastomotic leaks in ERP group vs. 5 in standard care group (p = 0.01)

Flatus returned earlier (POD 2 vs. POD 3, p = 0.0004); defecation occurred sooner (POD 3 vs. POD 4, p = 0.03) in ERP compared to standard care

More nasogastric tubes removed intraoperatively in ERP (87% vs. 61%, p = 0.0005) with no increase in replacements for postoperative ileus.

ERP patients had lower opioid consumption (19 mg vs. 32 mg, p = 0.028) to maintain a VAS pain score < 3

Iqbal et al. (2024) [28]

To evaluate the effectiveness of ERAS protocols compared to conventional care methods in patients undergoing elective colorectal surgery

Adult patients scheduled for elective colorectal surgery were divided into 2 equal groups (30 patients each) – ERAS (Group A) and conventional care (Group B)

Time to return of bowel sounds: Group A: 20.63 ± 2.66 h vs. Group B: 27.0 ± 2.07 h (P = 0.0001)

Time to first flatus: Group A: 18.67 ± 2.38 h vs. Group B: 25.93 ± 2.88 h (P = 0.0001)

Surgical Site Infections (SSI): Group A: 4 patients (13.33%) vs. Group B: 9 patients (30.0%) (P = 0.1172)