From enhanced recovery after surgery to fastest recovery after surgery: How fast is too fast in gastrointestinal tumor surgery?

Figure 1 From enhanced recovery after surgery plateau to fastest recovery after surgery: Conceptual framework and patient selection for safe accelerated recovery. Conceptual framework illustrating the transition from enhanced recovery after surgery (ERAS) to fastest recovery after surgery (FRAS) and the role of patient selection. A: ERAS leads to progressive improvement in postoperative recovery but eventually reaches a plateau with diminishing returns despite further optimization of individual components; B: FRAS represents a non-linear advancement beyond this plateau through synchronized implementation of perioperative interventions, including ultra-early oral intake, restrictive fluid management, and early drain removal, enabling accelerated recovery without compromising safety, as supported by recent clinical evidence; C: Safe application of FRAS depends on appropriate patient selection, integrating patient-related (e.g., functional status, American Society of Anesthesiologists class, frailty, nutritional status), surgical (e.g., minimally invasive approach, procedural complexity), and center-related factors to identify suitable candidates for accelerated recovery. ERAS: Enhanced recovery after surgery; FRAS: Fastest recovery after surgery; ASA: American Society of Anesthesiologists.