Zhang XL, Hong QQ, Huang YQ. Influence of enhanced recovery after surgery protocol on first exhaust time after laparoscopic resection of colorectal cancer. World J Gastrointest Surg 2026; 18(3): 116149 [DOI: 10.4240/wjgs.v18.i3.116149]
Corresponding Author of This Article
You-Qing Huang, Department of Hepatobiliary, Pancreatic and Vascular Surgery, The First Affiliated Hospital of Xiamen University, No. 55 Zhenhai Road, Siming District, Xiamen 361003, Fujian Province, China. 13695002565@163.com
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Gastroenterology & Hepatology
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Retrospective Study
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Mar 27, 2026 (publication date) through Mar 30, 2026
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World Journal of Gastrointestinal Surgery
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1948-9366
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Zhang XL, Hong QQ, Huang YQ. Influence of enhanced recovery after surgery protocol on first exhaust time after laparoscopic resection of colorectal cancer. World J Gastrointest Surg 2026; 18(3): 116149 [DOI: 10.4240/wjgs.v18.i3.116149]
World J Gastrointest Surg. Mar 27, 2026; 18(3): 116149 Published online Mar 27, 2026. doi: 10.4240/wjgs.v18.i3.116149
Influence of enhanced recovery after surgery protocol on first exhaust time after laparoscopic resection of colorectal cancer
Xiu-Lian Zhang, Qing-Qi Hong, You-Qing Huang
Xiu-Lian Zhang, Department of Colorectal Tumor Surgery, The First Affiliated Hospital of Xiamen University, Xiamen 361003, Fujian Province, China
Qing-Qi Hong, Department of Gastrointestinal Oncology Surgery, The First Affiliated Hospital of Xiamen University, Xiamen 361003, Fujian Province, China
You-Qing Huang, Department of Hepatobiliary, Pancreatic and Vascular Surgery, The First Affiliated Hospital of Xiamen University, Xiamen 361003, Fujian Province, China
Author contributions: Zhang XL and Hong QQ contributed to study design, patient recruitment, data collection, and data analysis; Zhang XL drafted the manuscript; Huang YQ conceptualized and supervised the study, provided critical revisions, and approved the final manuscript. All authors have read and approved the final version.
Institutional review board statement: This study was approved by the Ethics Committee of The First Affiliated Hospital of Xiamen University, No.[2023]KY-005.
Informed consent statement: Given the retrospective design of this study and the use of anonymized clinical data, the requirement for informed consent was waived by the Ethics Committee of the First Affiliated Hospital of Xiamen University.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data supporting the findings of this study are available from the corresponding author upon reasonable request. Due to patient privacy and institutional regulations, the raw clinical data cannot be publicly shared.
Corresponding author: You-Qing Huang, Department of Hepatobiliary, Pancreatic and Vascular Surgery, The First Affiliated Hospital of Xiamen University, No. 55 Zhenhai Road, Siming District, Xiamen 361003, Fujian Province, China. 13695002565@163.com
Received: November 18, 2025 Revised: December 10, 2025 Accepted: January 23, 2026 Published online: March 27, 2026 Processing time: 129 Days and 3.5 Hours
Abstract
BACKGROUND
Delayed gastrointestinal function recovery after laparoscopic colorectal cancer resection is an important factor affecting patient rehabilitation. Traditional perioperative management models lead to prolonged time to first flatus, seriously affecting postoperative recovery. The application of enhanced recovery after surgery (ERAS) concepts provides new insights for improving gastrointestinal function recovery.
AIM
To investigate the impact of ERAS protocol on time to first flatus after laparoscopic colorectal cancer resection.
METHODS
Eighty patients who underwent laparoscopic colorectal cancer resection at the Department of Colorectal Oncology Surgery, The First Affiliated Hospital of Xiamen University, from May 2023 to August 2024 were selected as study subjects and divided into conventional group (n = 40) and ERAS group (n = 40) according to different perioperative management protocols. The conventional group received traditional perioperative management protocol, while the ERAS group implemented ERAS protocol management based on conventional treatment, including optimized preoperative bowel preparation, shortened fasting time, optimized intraoperative fluid management, early postoperative mobilization, and early enteral nutrition. Time to first flatus, time to first defecation, time to bowel sounds recovery, length of hospital stay, and complication rates were compared between the two groups.
RESULTS
Compared to the conventional group, the ERAS group showed significantly shortened time to first flatus (2.2 ± 0.8 days vs 3.5 ± 1.2 days, P < 0.001), earlier time to first defecation (3.3 ± 1.0 days vs 4.8 ± 1.4 days, P < 0.001), and reduced time to bowel sounds recovery (2.5 ± 0.8 days vs 4.2 ± 1.3 days, P < 0.001). Mean hospital stay was significantly shortened in the ERAS group (9.1 ± 2.4 days vs 12.3 ± 3.2 days, P < 0.001), and postoperative complication rate was significantly reduced (12.5% vs 32.5%, P < 0.05). Statistically significant differences existed between the two groups in the incidence of gastrointestinal discomfort symptoms including abdominal distension, nausea, and vomiting (P < 0.05).
CONCLUSION
Application of ERAS protocol in laparoscopic colorectal cancer resection can effectively shorten time to first flatus, promote gastrointestinal function recovery, reduce hospital stay, and lower complication rates, demonstrating good clinical application value.
Core Tip: Enhanced recovery after surgery (ERAS) may accelerate gastrointestinal recovery after laparoscopic colorectal cancer resection, but time-to-first-flatus is rarely treated as a time-to-event endpoint. In this single-center retrospective cohort (n = 80), an ERAS pathway emphasizing shortened fasting with preoperative carbohydrates, goal-directed fluid therapy, multimodal analgesia, early mobilization, and early enteral nutrition was associated with a markedly earlier first flatus (approximately 1.3 days sooner), faster first defecation and bowel-sound recovery, fewer gastrointestinal symptoms, shorter length of stay (approximately 3.2 days reduction), and fewer complications. Analyses should prioritize survival methods (Kaplan-Meier, Cox/accelerated failure time) and adjust for secular trends and confounding (e.g., calendar month, operative factors, opioid use), with propensity techniques as sensitivity checks. Findings support routine ERAS implementation and adherence monitoring to improve postoperative intestinal function and hospitalization metrics, while acknowledging single-center, time-segmented design limitations.
