The Multidisciplinary Approach to Enhanced Recovery After Surgery in Colorectal Cancer: An Updated Narrative Review

Enhanced Recovery After Surgery (ERAS) has become the principal framework for perioperative care in elective colorectal cancer surgery, integrating multiple evidence-based interventions across the preoperative, intraoperative, and postoperative phases. Successful implementation depends not only on individual pathway components but on coordinated multidisciplinary delivery involving surgeons, anesthesiologists, nurses, dietitians, physiotherapists, pharmacists, and stoma-care specialists. This updated narrative review synthesizes contemporary evidence on the multidisciplinary implementation of ERAS in elective colorectal cancer surgery, drawing primarily on the 2025 ERAS Society recommendations together with literature published between January 2022 and August 2026, identified through structured searches of PubMed/MEDLINE and Scopus. Thirty-three publications were prioritized for narrative synthesis based on relevance, methodological quality, recency, and contribution to multidisciplinary implementation. The review examines preoperative optimization (patient education, prehabilitation, smoking and alcohol cessation, nutritional and hematologic optimization, bowel preparation), intraoperative-adjacent perioperative measures (fasting and carbohydrate loading, venous thromboembolism prophylaxis), and postoperative recovery components (catheter management, early oral feeding, mobilization, prevention of postoperative ileus, discharge planning), alongside pathway adherence, audit, and implementation science. Contemporary evidence continues to support core ERAS components, although the strength of evidence varies: carbohydrate loading and universal extended thromboprophylaxis, for example, show a less definitive effect on major outcomes than previously assumed, while specific mobilization targets remain pragmatic rather than proven thresholds. Nurses occupy a longitudinal, coordinating role across the entire perioperative trajectory. The findings indicate that ERAS effectiveness in colorectal cancer surgery depends less on individual interventions than on consistent multidisciplinary delivery, sustained pathway adherence, and systematic audit. Future research should prioritize individualized risk stratification, standardized adherence reporting, and rigorous evaluation of multidisciplinary implementation strategies rather than the addition of further isolated interventions.