[Expert consensus on hot issues in enhanced recovery after surgery perioperative management for gastric cancer patients undergoing neoadjuvant therapy (2026 version)].

This publication presents an expert consensus on perioperative Enhanced Recovery After Surgery (ERAS) management specifically for gastric cancer patients who have received neoadjuvant therapy (chemotherapy, immunotherapy, radiotherapy, and targeted therapy).

Key points:

• Rationale and Need:
  Patients post‑neoadjuvant treatment have distinct pathophysiologic features: higher rates of treatment‑related toxicity, worsened or new nutrition-related comorbidities, and increased cardiopulmonary impairment. These factors complicate standard ERAS pathways, highlighting the need for tailored protocols rather than simply applying traditional ERAS for surgery-alone patients.

• Scope of the Consensus:
  Developed by a national multidisciplinary expert group in China, the document provides recommendations on 21 core questions relevant to ERAS in this setting, using current evidence and adapting international experience to Chinese clinical practice.

• Major Content Domains:
  • Pathophysiological Basis:
    Describes how neoadjuvant therapy alters nutritional status, physical function, organ reserve, tissue quality (edema, fibrosis), and how these changes influence surgical difficulty, anastomotic healing, and complication risk.
  • Preoperative Prehabilitation:
    Emphasizes individualized nutritional optimization, functional/physical conditioning, and cardiopulmonary assessment and support to better prepare patients for surgery.
  • Intraoperative Management:
    Addresses strategies to manage tissue edema and fibrosis, mitigate operative difficulty, and protect anastomotic integrity within an ERAS framework.
  • Postoperative Rehabilitation:
    Provides guidance for early mobilization, tailored nutritional support, careful monitoring for complications, and refined recovery milestones in patients with prior systemic therapy.

• Intended Impact:
  The consensus aims to standardize and personalize ERAS protocols for this high‑risk subgroup to lower postoperative complication rates, improve overall prognosis, and enhance quality of life, while offering practical, evidence-informed guidance for clinicians in daily practice.