Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Gastrointest Surg. Nov 27, 2026; 18(11): 125939
Published online Nov 27, 2026. doi: 10.4240/wjgs.125939
Published online Nov 27, 2026. doi: 10.4240/wjgs.125939
Enhanced recovery after surgery in colorectal surgery: Do average benefits mask heterogeneous effects in patients underrepresented in trials?
Ying-Bin Ding, Department of Ultrasound Medicine, Harbin Hospital of Traditional Chinese Medicine, Harbin 150076, Heilongjiang Province, China
Hang Yu, Xue-Lei Zhan, Department of General Surgery, The First Hospital of Harbin, Harbin 150000, Heilongjiang Province, China
Co-first authors: Ying-Bin Ding and Hang Yu.
Author contributions: Ding YB conceived the review framework, executed database searches, completed primary literature screening, drafted the introduction and chapters 2 and 3, and performed quality appraisal of clinical cohort studies; Yu H collated cross-disciplinary evidence from human factors and safety science, synthesized registry data, and drafted chapters 4-6; Zhan XL supervised all research stages, standardized the narrative synthesis methodology, revised all chapters for logical consistency, checked all boundary compliance rules, and finalised the reference list; All authors read and approved the final submitted version. Ding YB and Yu H contributed equally as co-first authors.
AI contribution statement: The authors take full responsibility and accountability for all content of this manuscript, including any portions for which AI tools were used as assistive technologies. All AI-assisted outputs were carefully reviewed, validated, and approved by the authors. AI tools were not used to generate original scientific data, perform independent scientific analyses, or draw scientific conclusions.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Corresponding author: Xue-Lei Zhan, PhD, Chief Physician, Department of General Surgery, The First Hospital of Harbin, No. 151 Diduan Street, Daoli District, Harbin 150000, Heilongjiang Province, China. zhanxuelei@126.com
Received: July 21, 2026
Revised: August 10, 2026
Accepted: September 18, 2026
Published online: November 27, 2026
Processing time: 114 Days and 20.2 Hours
Revised: August 10, 2026
Accepted: September 18, 2026
Published online: November 27, 2026
Processing time: 114 Days and 20.2 Hours
Core Tip
Core Tip: Enhanced recovery after surgery audits capture whether a protocol element was actually carried out, not why it was omitted. The reasons for omitting a step are not all the same: Some deviations reflect clinical caution, others simple oversight. That distinction matters most when the patient in question does not resemble the trial populations on which the protocol was originally based. Audit systems that record the rationale for non-adherence, rather than merely its occurrence, have the potential to improve perioperative care, although this hypothesis requires prospective validation.