Enhanced recovery after surgery (ERAS®) society guidelines for gynecologic oncology: 2026 update

Gregg Nelson; Alon D Altman; Amy Metcalfe; Christina Fotopoulou; Jolyn Taylor; Gretchen Glaser; Jamie Bakkum-Gamez; Amanika Kumar; Larissa A Meyer; Rebecca Stone; Gabriel Mena; Kevin M Elias; Steven P Bisch; Oliver Zivanovic; Ester Miralpeix; Geetu Bhandoria; Ane Gerda Zahl Eriksson; Shannon M Ruzycki; Pervez Sultan; Khara M Sauro; Lindsay Blake; Mary E Brindle; Pedro T Ramirez; Sean C Dowdy

doi:10.1016/j.ygyno.2026.05.022

Enhanced recovery after surgery (ERAS®) society guidelines for gynecologic oncology: 2026 update

Gynecol Oncol. 2026 Jun 5:210:153-173. doi: 10.1016/j.ygyno.2026.05.022. Online ahead of print.

Authors

Gregg Nelson¹, Alon D Altman², Amy Metcalfe³, Christina Fotopoulou⁴, Jolyn Taylor⁵, Gretchen Glaser⁶, Jamie Bakkum-Gamez⁶, Amanika Kumar⁶, Larissa A Meyer⁵, Rebecca Stone⁷, Gabriel Mena⁸, Kevin M Elias⁹, Steven P Bisch¹⁰, Oliver Zivanovic¹¹, Ester Miralpeix¹², Geetu Bhandoria¹³, Ane Gerda Zahl Eriksson¹⁴, Shannon M Ruzycki¹⁵, Pervez Sultan¹⁶, Khara M Sauro¹⁷, Lindsay Blake¹⁸, Mary E Brindle¹⁹, Pedro T Ramirez²⁰, Sean C Dowdy⁶

Affiliations

¹ Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Electronic address: gregg.nelson@ahs.ca.
² Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
³ Departments of Obstetrics and Gynecology, Medicine, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
⁴ Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
⁵ Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁶ Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, MN, USA.
⁷ Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
⁸ Department of Anesthesiology, Critical Care and Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁹ Section of Gynecologic Oncology, Obstetrics and Gynecology Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
¹⁰ Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
¹¹ Heidelberg University Hospital, Department of Obstetrics and Gynecology, Heidelberg, Germany.
¹² Department of Obstetrics and Gynecology, Gynecological Cancer Multidisciplinary Unit, Hospital del Mar Research Institute, Barcelona, Spain.
¹³ Department of Gynecologic Oncology, Command Hospital, Kolkata, India.
¹⁴ Department of Gynaecological Oncology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
¹⁵ Departments of Medicine, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
¹⁶ Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
¹⁷ Departments of Surgery, Community Health Sciences, Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
¹⁸ UAMS Library, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
¹⁹ Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
²⁰ Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX, USA.

PMID: 42247726
DOI: 10.1016/j.ygyno.2026.05.022

Abstract

Background: This is the third updated enhanced recovery after surgery (ERAS®) society guideline presenting a consensus for optimal perioperative care in gynecologic oncology surgery.

Methods: A database search of publications using Embase and PubMed was performed (2018-2025). Studies for key elements within the ERAS gynecologic oncology protocol were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded according to the grading of recommendations, assessment, development and evaluation (GRADE) system.

Results: All recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly.

Conclusions: The updated evidence base and recommendation for items within the ERAS gynecologic oncology perioperative care pathway are presented by the ERAS® society in this consensus review. Gynecologic surgeons may consider incorporating these recommendations into perioperative pathway design, with efforts to achieve consensus within their practice where feasible.

Keywords: ERAS; Enhanced recovery after surgery; Gynecologic oncology surgery; Perioperative care; Surgical quality.

Publication types

Review