Letter to the Editor: Rethinking geriatric onco-surgery: A paradigm shift validates enhanced recovery after surgery for elderly gastric cancer patients

Table 1 Summary of three clinical studies on enhanced recovery after surgery in gastric-cancer patients

Ref.	Study design	Patient characteristics	Sample sizes	Key ERAS protocol elements	Primary outcome measures	Conclusions
Xiao et al[7]	Prospective study	Elderly gastric-cancer patients (age ≥ 70 years) undergoing gastrectomy	n = 100 (50 ERAS vs 50 conventional)	Preoperative carbohydrate loading, no nasogastric tube, early oral intake, early mobilization, etc.	Postoperative complications, length of stay, hospitalization costs, readmission rate	ERAS protocols can be safely applied to elderly gastric-cancer patients, significantly shortening post-operative length of stay without increasing complication risk
Cao et al[8]	RCT	Elderly gastric-cancer patients (age ≥ 65 years) undergoing laparoscopic total gastrectomy	n = 171 (85 ERAS vs 86 conventional)	Preoperative counselling, carbohydrate loading, no nasogastric tube, goal-directed fluid therapy, early feeding (starting POD 1), epidural analgesia, etc.	Length of stay, complications (Clavien-Dindo classification), immune marker (HLA-DR expression), inflammatory marker (CRP level)	ERAS is feasible and effective in elderly patients undergoing laparoscopic total gastrectomy; the benefits are linked to improved immune function and suppressed inflammatory response
Jeong et al[9]	Before-after propensity-score-matched study	Gastric-cancer patients undergoing gastrectomy (both distal and total procedures)	Pre-matching: 424 pre-ERAS vs 565 ERAS; post-matching: n = 219 each	18-item protocol: Preoperative carbohydrate loading, no drains, early oral intake (POD 1), restricted intravenous fluids, active mobilization, etc.	Length of stay, complications, readmission rate, re-operation rate	In real-world clinical practice, ERAS reduces hospital stay by approximately 3 days without raising readmission rates, confirming its tangible benefits

RCT: Randomized controlled trial; ERAS: Enhanced recovery after surgery; POD 1: Postoperative day 1; HLA: Human leukocyte antigen; CRP: C-reactive protein.