[Expert consensus on hot issues in enhanced recovery after surgery perioperative management for gastric cancer...

The concept of Enhanced Recovery After Surgery (ERAS) has been widely applied in the perioperative management of gastric cancer surgery. However, gastric cancer patients receiving neoadjuvant therapy present special pathophysiological characteristics, with a high risk of adverse reactions related to anti-tumor treatment, as well as a higher tendency to develop or exacerbate nutrition-related comorbidities and cardiopulmonary function impairment. It is necessary to refine and optimize the specific protocols of ERAS based on the individual conditions of patients. Nevertheless, clinicians lack a guiding consensus for the implementation of ERAS in gastric cancer patients after neoadjuvant therapy. For this reason, the Clinical Research Collaborative Group for Robotic Surgery of the Gastric Cancer Professional Committee of the Chinese Anti-Cancer Association has led experts in relevant domestic fields to formulate the "Expert consensus on hot issues in enhanced recovery after surgery perioperative management for gastric cancer patients undergoing neoadjuvant therapy (2026 version)" after reviewing domestic and international research findings, drawing on foreign experience and combining with domestic practical situations, following repeated discussions and expert validation. Targeting the hot issues in ERAS management for gastric cancer patients after neoadjuvant therapy (including chemotherapy, immunotherapy, radiotherapy and targeted therapy), this consensus puts forward recommendations for 21 core issues based on the latest evidence-based medical evidence, covering multiple dimensions such as pathophysiological basis, preoperative prehabilitation, intraoperative management and postoperative rehabilitation. It addresses the mechanisms underlying the impacts of neoadjuvant therapy on patients' nutritional status, functional capacity and organ function, as well as the challenges and countermeasures of tissue edema and fibrosis on surgical difficulty and anastomotic healing. This consensus aims to provide clinical practitioners with standardized and individualized guidance for perioperative management, so as to reduce postoperative complications, improve patients' prognosis and enhance their quality of life.