The Impact of Enhanced Recovery after Surgery Protocol on Health-Related Quality of Life Following Colorectal Surgery: a Literature Review

Background: Enhanced recovery after surgery (ERAS) protocols are widely adopted in colorectal surgery to reduce postoperative complications, length of stay and costs, but their impact on health-related quality of life (HRQoL) is less clear. Methods: A literature review was conducted through PubMed (MEDLINE) to December 2024, including randomized trials and observational studies evaluating ERAS implementation in colorectal surgery with HRQoL as primary or secondary outcome, using validated or clearly described HRQoL instruments. Results: Fifteen studies met the inclusion criteria, encompassing heterogeneous patient populations, procedures and ERAS pathways. Early randomized trials generally reported no significant differences in global HRQoL scores between ERAS and standard care, although ERAS cohorts frequently showed faster recovery of instrumental activities of daily living, earlier return to leisure or work and shorter hospitalization without increased complications. More recent studies, including larger prospective series, increasingly demonstrated higher HRQoL scores in ERAS groups across multiple domains using instruments such as EORTC QLQ-CR38 and WHOQOL-BREF, and identified non-ERAS perioperative care as an independent negative prognostic factor for long-term HRQoL improvement. No study reported detrimental effects of ERAS on HRQoL. Conclusions: The available evidence, although limited and methodologically heterogeneous, suggests that ERAS protocols in colorectal surgery have a neutral to beneficial impact on HRQoL, while maintaining well-established clinical advantages. Future research should include rigorously designed studies with HRQoL as a primary endpoint, standardized ERAS components and consistent use of validated HRQoL tools to allow more definitive recommendations.