Wang SY, Kang BY, Chen XF. Letter to the Editor: Rethinking geriatric onco-surgery: A paradigm shift validates enhanced recovery after surgery for elderly gastric cancer patients. World J Gastrointest Surg 2026; 18(5): 116446 [DOI: 10.4240/wjgs.v18.i5.116446]
Corresponding Author of This Article
Xiao-Feng Chen, MD, PhD, Postdoc, Professor, Department of Emergency Medicine, PLA Air Force Hospital of Eastern Theater Command, No. 1 Malu Street, Qinhuai District, Nanjing 210002, Jiangsu Province, China. cxf13372025799@163.com
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Gastroenterology & Hepatology
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letter
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Wang SY, Kang BY, Chen XF. Letter to the Editor: Rethinking geriatric onco-surgery: A paradigm shift validates enhanced recovery after surgery for elderly gastric cancer patients. World J Gastrointest Surg 2026; 18(5): 116446 [DOI: 10.4240/wjgs.v18.i5.116446]
World J Gastrointest Surg. May 27, 2026; 18(5): 116446 Published online May 27, 2026. doi: 10.4240/wjgs.v18.i5.116446
Letter to the Editor: Rethinking geriatric onco-surgery: A paradigm shift validates enhanced recovery after surgery for elderly gastric cancer patients
Si-Yuan Wang, Bo-Yu Kang, Xiao-Feng Chen
Si-Yuan Wang, Department of General Surgery, The 989th Hospital of the Joint Logistic Support Force of PLA, Luoyang 471031, Henan Province, China
Si-Yuan Wang, Bo-Yu Kang, Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, The First Affiliated Hospital of Air Force Medical University, Xi’an 710004, Shaanxi Province, China
Bo-Yu Kang, Department of Experiment Surgery, The First Affiliated Hospital of Air Force Medical University, Xi’an 710032, Shaanxi Province, China
Xiao-Feng Chen, Department of Emergency Medicine, PLA Air Force Hospital of Eastern Theater Command, Nanjing 210002, Jiangsu Province, China
Co-first authors: Si-Yuan Wang and Bo-Yu Kang.
Author contributions: Wang SY and Kang BY contributed to performed most of the results, completed the manuscript, revise the manuscript together, and they contributed equally to this manuscript and are co-first authors; Chen XF contributed to designed the study. All authors read and approved the final manuscript.
AI contribution statement: We solemnly state that no AI tools were used throughout the manuscript writing and revision process. All content was finished independently by the authors.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Xiao-Feng Chen, MD, PhD, Postdoc, Professor, Department of Emergency Medicine, PLA Air Force Hospital of Eastern Theater Command, No. 1 Malu Street, Qinhuai District, Nanjing 210002, Jiangsu Province, China. cxf13372025799@163.com
Received: November 12, 2025 Revised: December 1, 2025 Accepted: January 4, 2026 Published online: May 27, 2026 Processing time: 197 Days and 6.8 Hours
Abstract
The rising incidence of gastric cancer in an aging population poses a significant surgical challenge, as elderly patients often present with greater comorbidities, leading to concerns about their ability to tolerate standardized enhanced recovery after surgery (ERAS) protocols. The groundbreaking retrospective study by Li et al, directly addresses this critical evidence gap. Their study demonstrates that the application of ERAS protocols in elderly patients is feasible and safe, its management measures are universally applicable to patients of different ages, and separate ERAS management pathways for elderly patients are not required. Although elderly patients were significantly worse than young patients in terms of underlying diseases such as hypertension, diabetes, respiratory system diseases and cardiovascular system diseases, there were no significant differences in the ERAS protocol compliance rate, anastomotic leakage rate, incision infection rate, pulmonary infection rate, reoperation rate and postoperative mortality. We argue that the work of Li et al catalyzes a paradigm shift, advocating for the universal application of evidence-based ERAS protocols across all age groups. This mandates a reevaluation of clinical practice and guidelines to ensure that elderly patients are not inadvertently deprived of the proven benefits of standardized ERAS pathways, thereby promoting equitable and optimal surgical outcomes for the growing geriatric oncological population.
Core Tip: Against the backdrop of the escalating global health burden of gastric cancer in older adults, refining postoperative rehabilitation strategies is crucial for enhancing prognosis and improving quality of life in this population. A retrospective study conducted by Li et al on 161 older gastric cancer patients who underwent Enhanced recovery after surgery (ERAS) provided robust evidence supporting the clinical adoption of ERAS protocols. Additionally, the study offered critical implementation insights into perioperative pathway execution in routine practice. However, the study is constrained by its retrospective, single-center design; future investigations should prioritize multicenter, prospective cohorts to elevate the level of evidence and accelerate clinical translation. Equally important, real-world adherence to ERAS protocols must be rigorously evaluated.
