Turan B, Sabuncuoglu MZ. From enhanced recovery after surgery to fastest recovery after surgery: How fast is too fast in gastrointestinal tumor surgery? World J Gastrointest Surg 2026; 18(7): 119763 [DOI: 10.4240/wjgs.v18.i7.119763]
Corresponding Author of This Article
Bilal Turan, MD, Assistant Professor, Researcher, Department of General Surgery, Faculty of Medicine, Suleyman Demirel University, Arastirma ve Uygulama Hastanesi, Isparta 32260, Türkiye. bturan117@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
review-article
Open-Access Policy of This Article
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/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Turan B, Sabuncuoglu MZ. From enhanced recovery after surgery to fastest recovery after surgery: How fast is too fast in gastrointestinal tumor surgery? World J Gastrointest Surg 2026; 18(7): 119763 [DOI: 10.4240/wjgs.v18.i7.119763]
World J Gastrointest Surg. Jul 27, 2026; 18(7): 119763 Published online Jul 27, 2026. doi: 10.4240/wjgs.v18.i7.119763
From enhanced recovery after surgery to fastest recovery after surgery: How fast is too fast in gastrointestinal tumor surgery?
Bilal Turan, Mehmet Zafer Sabuncuoglu
Bilal Turan, Department of General Surgery, Faculty of Medicine, Suleyman Demirel University, Isparta 32260, Türkiye
Mehmet Zafer Sabuncuoglu, Department of General Surgery, Faculty of Medicine, Akdeniz University, Antalya 07070, Türkiye
Author contributions: Turan B conceived the editorial concept, performed the literature interpretation, and drafted the manuscript; Sabuncuoglu MZ critically revised the manuscript for important intellectual content and contributed to the conceptual refinement. Both authors approved the final version of the manuscript and agree to be accountable for all aspects of the work.
AI contribution statement: AI tools were used solely for language polishing and translation.
Conflict-of-interest statement: The authors declare no competing interests.
Corresponding author: Bilal Turan, MD, Assistant Professor, Researcher, Department of General Surgery, Faculty of Medicine, Suleyman Demirel University, Arastirma ve Uygulama Hastanesi, Isparta 32260, Türkiye. bturan117@gmail.com
Received: February 5, 2026 Revised: March 6, 2026 Accepted: April 22, 2026 Published online: July 27, 2026 Processing time: 172 Days and 20 Hours
Abstract
Enhanced recovery after surgery (ERAS) has transformed perioperative care in gastrointestinal surgery by reducing surgical stress, shortening hospital stay, and improving patient-centered outcomes. However, as ERAS pathways have become widely standardized, further acceleration of recovery appears to have reached a practical plateau. The emerging concept of fastest recovery after surgery (FRAS) challenges this limit by emphasizing the intensified timing and synchronized integration of established perioperative interventions. Recent retrospective data suggests that FRAS may enable ultra-short postoperative recovery, achieving a median hospital stay of approximately 22 hours without increasing complication rates, while also improving early quality of life and patient satisfaction. Importantly, FRAS does not rely on a single novel intervention but on the coordinated optimization of multiple ERAS components, including ultra-early oral intake, restrictive fluid management, and early drain removal. This raises a key conceptual question: Whether recovery follows a linear trajectory or requires a threshold-based shift across multiple perioperative domains. Nevertheless, FRAS should not be considered a universal protocol. Its feasibility appears limited to carefully selected patients treated in experienced centers. From an editorial perspective, FRAS is best understood not as a replacement for ERAS but as its strategic extension, emphasizing individualized, patient-tailored recovery pathways. Accordingly, the future of perioperative care may depend less on pursuing uniformly faster recovery and more on defining the optimal recovery trajectory based on patient-specific factors and perioperative risk.
Core Tip: Enhanced recovery after surgery (ERAS) has transformed perioperative care in gastrointestinal surgery, yet further acceleration of recovery appears to have reached a practical plateau. The emerging concept of fastest recovery after surgery (FRAS) challenges this limit by emphasizing synchronized optimization of perioperative interventions rather than simple acceleration of individual ERAS components. Importantly, FRAS should not be viewed as a universal protocol but as a selective strategy that depends on appropriate patient selection, institutional experience, and clearly defined safety thresholds.
