Wang G, Pan SJ. From feasibility to biological recovery: Reframing enhanced recovery pathways for elderly gastric cancer patients. World J Gastroenterol 2026; 32(7): 116264 [DOI: 10.3748/wjg.v32.i7.116264]
Corresponding Author of This Article
Gang Wang, MD, PhD, Professor, Department of General Surgery, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou 215006, Jiangsu Province, China. 286651551@qq.com
Research Domain of This Article
Gastroenterology & Hepatology
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Editorial
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Feb 21, 2026 (publication date) through Feb 6, 2026
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Publication Name
World Journal of Gastroenterology
ISSN
1007-9327
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Wang G, Pan SJ. From feasibility to biological recovery: Reframing enhanced recovery pathways for elderly gastric cancer patients. World J Gastroenterol 2026; 32(7): 116264 [DOI: 10.3748/wjg.v32.i7.116264]
World J Gastroenterol. Feb 21, 2026; 32(7): 116264 Published online Feb 21, 2026. doi: 10.3748/wjg.v32.i7.116264
From feasibility to biological recovery: Reframing enhanced recovery pathways for elderly gastric cancer patients
Gang Wang, Sheng-Jie Pan
Gang Wang, Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
Sheng-Jie Pan, Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
Co-corresponding authors: Gang Wang and Sheng-Jie Pan.
Author contributions: Pan SJ contributed to conceptualization, methodology, investigation, data curation, formal analysis, visualization, writing-original draft, supervision. Wang G contributed to conceptualization, project administration, validation, resources, writing-review & editing. Wang G and Pan SJ contributed equally to this work as co-corresponding authors, with shared responsibility for study conception, overall supervision, and final approval of the manuscript. All authors read and approved the final manuscript and agree to be accountable for all aspects of the work.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gang Wang, MD, PhD, Professor, Department of General Surgery, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou 215006, Jiangsu Province, China. 286651551@qq.com
Received: November 6, 2025 Revised: November 22, 2025 Accepted: December 29, 2025 Published online: February 21, 2026 Processing time: 92 Days and 6.8 Hours
Abstract
Enhanced recovery after surgery (ERAS) has reshaped perioperative care in gastrointestinal oncology, but its application in elderly gastric cancer patients requires a shift from feasibility toward a biologically grounded understanding of recovery. Aging is characterized by frailty, sarcopenia, multimorbidity, chronic inflammation, and circadian vulnerability, which collectively influence postoperative resilience. Contemporary evidence shows that ERAS pathways remain feasible and safe in older adults, yet responsiveness varies widely due to physiological heterogeneity rather than chronological age alone. This Editorial reframes recovery as a multidomain process encompassing nutritional-inflammatory balance, sleep-circadian regulation, psychological resilience, and functional mobility. Targeted perioperative nutrition may support metabolic competence; structured sleep-protection strategies can stabilize endocrine-immune rhythms; psychological interventions may mitigate stress-related inflammatory activation; and digital monitoring using step-count trajectories or heart-rate variability provides early indicators of recovery deviation. Implementation challenges-including clinical workload, variable frailty, cognitive impairments, digital acceptance, and uneven access to multidisciplinary expertise-highlight the need for adaptive and pragmatic pathways. As global aging accelerates, ERAS must evolve from standardized protocols to biologically informed, patient-centered systems that align interventions with host physiology and real-time recovery signals. Such an approach may better capture recovery depth, enhance functional outcomes, and promote equitable care for elderly surgical populations.
Core Tip: Enhanced recovery after surgery (ERAS) has demonstrated safety and feasibility for elderly patients with gastric cancer, but feasibility alone does not define success. This editorial reframes ERAS as a pathway toward functional recovery-restoring biological resilience, metabolic homeostasis, and circadian stability while preserving independence. By integrating psychophysiological support, nutritional-inflammatory modulation, and digital monitoring, ERAS can evolve into an adaptive, precision rehabilitation model that bridges chronological age and biological potential.
