Enhanced Recovery After Surgery (ERAS) in lung cancer surgery: Evidence, challenges, and perspectives for implementation in Kazakhstan (A literature review)

Abstract

Relevance: Enhanced Recovery After Surgery (ERAS) and the Fast-Track rehabilitation concept represent a modern multidisciplinary model of perioperative management aimed at reducing surgical stress, minimizing postoperative complications, and accelerating functional recovery. In thoracic surgery, the implementation of ERAS principles encompasses the entire perioperative pathway—from prehabilitation and minimally invasive techniques to multimodal analgesia, early mobilization, and nutritional optimization. Despite proven effectiveness, in Kazakhstan, individual elements of accelerated recovery are applied inconsistently, and the concept itself remains underrepresented in the professional community. Conducting a literature review on this topic is the first step toward forming the scientific and clinical foundation necessary for subsequent adaptation and implementation of ERAS principles within the national healthcare system.

The study aimed to provide an analytical review of current evidence on the concepts of Enhanced Recovery After Surgery (ERAS) and Fast-Track rehabilitation in the surgical treatment of non-small cell lung cancer.

Materials and Methods: A literature search was conducted across international bibliographic databases, including PubMed, PubMed Central, Scopus, and Google Scholar, using combinations of keywords such as lung cancer, ERAS, Fast-Track, and lung resection. The initial search identified more than 300 publications. After removal of duplicates and exclusion of studies that did not meet the predefined inclusion criteria, 28 studies were included in the final analytical review.

Results: The implementation of minimally invasive surgical approaches (VATS) in lung cancer is not associated with an increased rate of postoperative complications; however, the risk of pulmonary and cardiorespiratory adverse events remains. According to meta-analyses, the use of ERAS protocols is associated with a significant reduction in postoperative complications and a decrease in length of hospital stay by approximately 2–3 days, without an increase in mortality or readmission rates, particularly when high protocol compliance is achieved.

Conclusion: ERAS protocols in thoracic surgery have demonstrated proven efficacy and safety, contributing to reduced postoperative complications, shorter hospital stay, and lower treatment costs without increasing mortality. Successful implementation requires standardization, multidisciplinary collaboration, and systematic monitoring. In Kazakhstan, the integration of ERAS remains limited, underscoring the need to adapt international recommendations and implement them in a stepwise manner within the national healthcare system.