Perioperative impact of enhanced recovery after surgery (ERAS) for minimally invasive colorectal resection: a systematic review and meta-analysis.

[PURPOSE] The added value of Enhanced Recovery After Surgery protocols in minimally invasive colorectal surgery remains debated. This study synthesized available evidence to examine how ERAS performs in minimally invasive colorectal resection, with attention to both effectiveness and safety.

[METHODS] We conducted a systematic review of these documents, covering key databases such as the Cochrane Library, PubMed, EMBASE, and Web of Science. The latest information was updated up to December 2025. Data analyses were conducted using STATA 18. Continuous outcomes were expressed as weighted mean differences, while categorical outcomes were summarized with odds ratios, each accompanied by 95% confidence intervals. The rigor of the included studies was appraised using the Newcastle-Ottawa Scale (NOS).

[RESULTS] Five eligible studies encompassing 2324 patients were synthesized. Compared with conventional care, ERAS implementation was associated with a meaningful reduction in length of hospital stay (WMD = - 2.38 days; 95% CI: -4.16, - 0.61; P < 0.01), alongside fewer overall postoperative complications (OR = 0.55; 95% CI: 0.44, 0.68; P < 0.05) and a decreased occurrence of postoperative ileus (OR = 0.57; 95% CI: 0.38, 0.86; P < 0.05). Readmission rates were comparable between groups (OR = 0.99, 95% CI: 0.55, 1.79; P = 0.952), and no meaningful difference was observed in operative time (WMD = 3.53, 95% CI: -15.76, 22.81; P = 0.115).

[CONCLUSIONS] ERAS protocols act synergistically with minimally invasive colorectal surgery to accelerate recovery and reduce complications without compromising safety. Future investigations with prospective designs are needed to confirm the robustness of these results.