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

Figure 2 Clinical decision algorithm for the implementation of fastest recovery after surgery. Stepwise clinical decision algorithm for the safe implementation of fastest recovery after surgery (FRAS). The process begins with assessment of patient-related factors, including physiological reserve, frailty status, and nutritional condition, to determine suitability for accelerated recovery. Patients meeting these criteria proceed to surgical evaluation, where procedural complexity, minimally invasive approach, and intraoperative course are considered. Institutional readiness represents a critical prerequisite and includes established enhanced recovery after surgery (ERAS) experience, multidisciplinary coordination, and the ability to detect and manage early postoperative complications. Only when all conditions are satisfied should the FRAS protocol be implemented, incorporating synchronized perioperative strategies such as ultra-early oral intake, restrictive fluid management, and early drain removal. Continuous postoperative reassessment is essential, and patients who do not meet predefined discharge criteria should be transitioned to a conventional ERAS pathway. This algorithm emphasizes that FRAS is a selective, patient-centered strategy rather than a universally applicable protocol. ERAS: Enhanced recovery after surgery; FRAS: Fastest recovery after surgery; ASA: American Society of Anesthesiologists.