From feasibility to biological recovery: Reframing enhanced recovery pathways for elderly gastric cancer patients

Figure 1 Integrative framework of psychophysiological, nutritional, and metabolic axes within enhanced recovery after surgery pathways in elderly gastric cancer surgery. The schematic illustrates how multidomain perioperative interventions-nutritional-inflammatory modulation, circadian and sleep regulation, psychological resilience, and digital monitoring-interact through mechanistic axes involving inflammation control, metabolic competence, and autonomic-endocrine-immune balance. These pathways converge toward hypothesis-driven clinical outcomes including reduced short-term complications, improved functional independence, and potential long-term survival benefits. Implementation is governed by biomarker-guided (“if-then”) triggers, multidisciplinary oversight, and prospective validation to ensure safety and causal inference.