Enhanced recovery after surgery pathways and postoperative gastrointestinal function in colorectal cancer: A prospective cohort study

doi:10.4240/wjgs.v18.i2.115050

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Feb 27, 2026 (publication date) through Feb 26, 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

Prospective Study

©Author(s) (or their employer(s)) 2026. No commercial re-use. See Permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Surg. Feb 27, 2026; 18(2): 115050
Published online Feb 27, 2026. doi: 10.4240/wjgs.v18.i2.115050

Table 1 General data for patients

Indicators	Experimental group (n = 61)	Control group (n = 61)	χ²/t	P value
Age (years)	58.32 ± 9.41	59.17 ± 9.08	0.508	0.613
Sex (male/female)	35/26	36/25	0.034	0.854
Body weight (kg)	66.42 ± 9.37	67.15 ± 8.95	0.440	0.661
Height (cm)	167.82 ± 6.41	168.37 ± 6.12	0.485	0.629
BMI (kg/m²)	23.61 ± 2.58	23.74 ± 2.51	0.282	0.778
Hypertension, n (%)	12 (19.7)	13 (21.3)	0.050	0.823
Diabetes, n (%)	9 (14.8)	8 (13.1)	0.068	0.794
Clinical staging of tumors (II/III)	27/34	28/33	0.033	0.856
Surgery time (min)	163.45 ± 25.61	165.28 ± 26.13	0.391	0.697
Amount of bleeding (mL)	162.31 ± 41.28	165.19 ± 42.17	0.381	0.704
ASA score (I/II/III)	12/36/13	13/35/13	0.054	0.973
Hb pre-surgery (g/L)	128.52 ± 12.61	127.41 ± 12.37	0.491	0.625
Hb 3 days after surgery (g/L)	116.37 ± 11.28	115.42 ± 11.95	0.452	0.652
Hb 7 days after surgery (g/L)	121.42 ± 10.96	120.35 ± 11.27	0.532	0.596
ALB pre-surgery (g/L)	39.18 ± 4.26	38.92 ± 4.11	0.343	0.732
ALB 3 days after surgery (g/L)	35.27 ± 3.81	35.11 ± 3.74	0.234	0.815
ALB 7 days after surgery (g/L)	37.42 ± 3.65	37.11 ± 3.58	0.474	0.637
Cr pre-surgery (mol/L)	72.41 ± 10.18	73.05 ± 10.32	0.345	0.731
Cr 3 days after surgery (mol/L)	74.16 ± 10.27	74.92 ± 10.15	0.411	0.682
Cr 7 days after surgery (mol/L)	71.84 ± 9.95	72.36 ± 10.12	0.286	0.775

BMI: Body mass index; ASA: Association of Anesthesiologist; Hb: Hemoglobin; ALB: Albumin; Cr: Creatinine.

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Table 2 Recovery time of gastrointestinal peristalsis of patients

Group	Cases (n)	Peristalsis recovery time (hour)	Delayed recovery, n (%)
Experimental group	61	14.82 ± 3.46	3 (4.9)
Control group	61	19.63 ± 4.12	11 (18.0)
χ²/t		6.983	5.164
P value		< 0.001	0.023

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Table 3 Exhaust time for patients

Indicators	Experimental group (n = 61)	Control group (n = 61)	χ²/t	P value
Exhaust time (hour)	28.35 ± 6.42	36.27 ± 7.15	6.437	< 0.001
Delayed exhaust, n (%)	5 (8.2)	14 (23.0)	5.050	0.025

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Table 4 First defecation time for patients

Indicators	Experimental group (n = 61)	Control group (n = 61)	χ²/t	P value
Defecation time (hour)	54.68 ± 10.25	66.39 ± 11.72	5.874	< 0.001
Delayed defecation, n (%)	6 (9.8)	16 (26.2)	5.546	0.019

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Table 5 Postoperative pain scores for patients

Indicators	Experimental group (n = 61)	Control group (n = 61)	χ²/t	P value
VAS score (points)	3.87 ± 0.56	4.38 ± 0.74	4.292	< 0.001
Moderate or severe pain, n (%)	4 (6.6)	12 (19.7)	4.604	0.032

VAS: Visual analog scale.

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Table 6 Postoperative complications for patients, n (%)

Types of complications	Experimental group (n = 61)	Control group (n = 61)	χ²	P value
Bowel obstruction	2 (3.3)	5 (8.2)	0.606	0.436
Bleeding	1 (1.6)	3 (4.9)	0.259	0.611
Infection	4 (6.6)	9 (14.8)	2.152	0.142
Total complications	7 (11.5)	17 (27.9)	5.187	0.023

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Table 7 Rehabilitation training compliance and functional outcomes between groups

Indicator	Group	Postoperative day 1	Postoperative day 3	Postoperative day 7	χ²/t	P value
Compliance rate (%)
Respiratory training	Experimental	92.17 ± 5.23	94.85 ± 4.71	96.32 ± 3.89	1.832	0.07
	Control	10.25 ± 8.41	12.48 ± 9.62	15.73 ± 10.55
Bed activities	Experimental	90.45 ± 6.12	93.68 ± 5.34	95.18 ± 4.75	2.114	0.037
	Control	8.96 ± 7.83	11.27 ± 8.94	14.52 ± 9.81
Early ambulation	Experimental	85.32 ± 7.45	89.41 ± 6.58	92.67 ± 5.12	2.548	0.012
	Control	5.83 ± 6.72	8.15 ± 7.63	11.46 ± 8.72
Abdominal massage	Experimental	88.19 ± 6.84	90.76 ± 5.97	93.54 ± 4.86	1.976	0.051
	Control	7.41 ± 7.15	9.88 ± 8.26	13.21 ± 9.44
Ambulation duration (minute/day)	Experimental	18.45 ± 5.32	35.67 ± 8.91	58.24 ± 12.36	6.128	< 0.001
	Control	5.83 ± 4.17	12.45 ± 6.83	25.71 ± 9.58
Time to first ambulation (hour)	Experimental	12.58 ± 2.41	-	-	8.245	< 0.001
	Control	28.93 ± 6.72	-	-

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Table 8 Quality of life scores (EORTC QLQ-C30) at different time points

Domain	Group	Preoperative	7 days postop	30 days postop	F/time effect (P value)	F/group effect (P value)	F/interaction (P value)
Physical function	Experimental	85.21 ± 6.32	70.14 ± 7.21	82.35 ± 6.78	185.326 (< 0.001)	22.174 (< 0.001)	15.893 (< 0.001)
	Control	84.67 ± 6.48	62.28 ± 8.12	74.62 ± 7.45
t (Exp vs Con)		0.462	5.583	5.823
P value		0.645	< 0.001	< 0.001
Role function	Experimental	83.52 ± 7.08	68.35 ± 6.87	80.18 ± 6.52	162.754 (< 0.001)	19.835 (< 0.001)	13.742 (< 0.001)
	Control	82.93 ± 7.25	60.08 ± 7.76	72.83 ± 7.09
t (Exp vs Con)		0.448	6.128	5.942
P value		0.655	< 0.001	< 0.001
Emotional function	Experimental	79.84 ± 8.15	72.46 ± 7.35	78.57 ± 6.98	98.634 (< 0.001)	15.724 (< 0.001)	9.865 (0.001)
	Control	78.62 ± 8.36	65.32 ± 8.57	71.24 ± 7.85
t		0.785	4.872	5.367
P value		0.434	< 0.001	< 0.001
GI symptoms	Experimental	12.35 ± 3.08	28.57 ± 4.48	16.28 ± 3.75	245.718 (< 0.001)	28.463 (< 0.001)	18.924 (< 0.001)
	Control	13.12 ± 3.26	38.21 ± 5.06	24.68 ± 4.23
t		-1.325	-10.845	-11.274
P value		0.188	< 0.001	< 0.001

GI: Gastrointestinal.

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Table 9 Multi-factor Logistics regression analysis

Independent variable	β	SE	χ²	P value	OR	95%CI
Constant term	-2.41	0.87	7.676	0.006	-	-
Treatment group (ERAS vs control)	-1.14	0.5	5.184	0.022	0.32	0.12-0.85
Age (years)	0.01	0.02	0.27	0.603	1.01	0.97-1.05
Gender (male vs female)	0.11	0.4	0.075	0.785	1.12	0.51-2.46
BMI (kg/m²)	-0.05	0.08	0.388	0.534	0.95	0.82-1.11
Surgery time (min)	0.04	0.01	6.976	0.009	1.04	1.01-1.07
Intraoperative bleeding volume (mL)	0.02	0.01	4.623	0.031	1.02	1.00-1.04
ASA score (I/II/III)	0.1	0.17	0.348	0.555	1.11	0.67-1.85

ERAS: Enhanced recovery after surgery; BMI: Body mass index; ASA: Association of Anesthesiologist.

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Table 10 Subgroup analysis of gastrointestinal function recovery and complications

Subgroup	Indicator	ERAS group (n = 61)	Control group (n = 61)	t/χ²	P value
Age ≥ 70 years (n = 28)	Time to first exhaust (hour)	29.82 ± 5.24	38.53 ± 6.81	4.328	< 0.001
	Time to first defecation (hour)	57.35 ± 9.12	70.24 ± 10.53	4.128	< 0.001
	Complications, n (%)	3 (10.71)	8 (28.57)	4.152	0.042
With diabetes/hypertension (n = 42)	Time to first exhaust (hour)	27.94 ± 4.83	37.12 ± 6.35	5.842	< 0.001
	Time to first defecation (hour)	55.64 ± 8.72	68.93 ± 9.84	5.327	< 0.001
	Complications, n (%)	4 (9.52)	10 (23.81)	4.462	0.035
Stage III tumors (n = 67)	Time to first exhaust (hour)	30.24 ± 5.63	39.82 ± 7.14	6.128	< 0.001
	Time to first defecation (hour)	58.73 ± 9.52	72.42 ± 11.35	5.884	< 0.001
	Complications, n (%)	5 (7.46)	14 (20.90)	5.724	0.016

ERAS: Enhanced recovery after surgery.

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Table 11 Inflammatory factors and intestinal barrier function indicators

Indicator	Group	Preoperative	Postoperative day 1	Postoperative day 3	F (time)	P (time)	F (group)	P (group)
IL-6 (pg/mL)	ERAS	15.32 ± 3.25	48.65 ± 8.74	28.41 ± 5.63	185.327	< 0.001	45.218	< 0.001
	Control	15.87 ± 3.41	78.92 ± 12.35	45.68 ± 7.92
CRP (mg/L)	ERAS	3.25 ± 1.02	35.68 ± 6.47	18.42 ± 4.15	203.451	< 0.001	52.174	< 0.001
	Control	3.41 ± 1.11	62.15 ± 9.83	32.57 ± 5.86
D-lactic acid (μg/mL)	ERAS	1.52 ± 0.38	4.25 ± 1.02	2.68 ± 0.75	165.832	< 0.001	38.965	< 0.001
	Control	1.58 ± 0.42	7.83 ± 1.87	4.92 ± 1.24
Endotoxin (EU/mL)	ERAS	0.25 ± 0.08	0.68 ± 0.15	0.42 ± 0.11	142.736	< 0.001	41.283	< 0.001
	Control	0.26 ± 0.09	1.25 ± 0.28	0.87 ± 0.19

IL-6: Interleukin-6; CRP: C-reactive protein; ERAS: Enhanced recovery after surgery.

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Citation: Zhao BH, Bao CX. Enhanced recovery after surgery pathways and postoperative gastrointestinal function in colorectal cancer: A prospective cohort study. World J Gastrointest Surg 2026; 18(2): 115050
URL: https://www.wjgnet.com/1948-9366/full/v18/i2/115050.htm
DOI: https://dx.doi.org/10.4240/wjgs.v18.i2.115050