Annals of Clinical Nutrition and Metabolism

The 2024 Korean Enhanced Recovery After Surgery guidelines for hepatobiliary and pancreatic surgery: Kwangpyo Hong, Hongbeom Kim, Hyung Sun Kim, Hae Won Lee, Ho Joong Choi, YoungRok Choi, Jae Do Yang, Sung-Moon Jeong, Dae Wook Hwang, Do Joong Park, Sang-Jae Park, The Korean Enhanced Recovery After Surgery (ERAS) Committee within the Korean Society of Surgical Metabolism and Nutrition; Ann Clin Nutr Metab 2025;17(3):172-180. Published online December 1, 2025; DOI: https://doi.org/10.15747/ACNM.25.0034

Purpose
The Korean Enhanced Recovery After Surgery (ERAS) Committee within the Korean Society of Surgical Metabolism and Nutrition has developed comprehensive guidelines for hepatobiliary and pancreatic (HBP) surgery by adapting established international protocols. These guidelines provide evidence-based recommendations specifically tailored to the Korean healthcare system and address perioperative management for both pancreatoduodenectomy and hepatectomy.
Methods
The HBP subcommittee reviewed existing international ERAS guidelines and conducted an adaptation process. Key questions were identified based on national survey results from Korean HBP surgeons and were prioritized according to clinical relevance. The committee focused on elements supported by moderate- to high-quality evidence with strong recommendation grades. Literature searches were conducted through January 2025, and evidence quality was evaluated using GRADE methodology. Four key questions underwent formal assessment, and eight additional questions were adapted from international guidelines.
Results
Twelve key questions were selected and addressed, covering critical perioperative care domains: prehabilitation, preoperative nutritional assessment and support, anti-thrombotic prophylaxis, prophylactic abdominal drainage, preoperative biliary drainage, smoking and alcohol cessation, pre-anesthetic medication, minimally invasive surgical approaches, prophylactic nasogastric intubation, postoperative glycemic control, perianastomotic drainage management, and early mobilization protocols. Each recommendation was assigned specific evidence levels and graded for strength. High-quality evidence supported strong recommendations for the routine avoidance of prophylactic drainage in uncomplicated hepatectomy, early drain removal after pancreatoduodenectomy in low-risk patients, elimination of routine nasogastric decompression, and the implementation of early mobilization strategies.
Conclusion
These Korean-adapted ERAS guidelines for HBP surgery are expected to standardize perioperative care, reduce postoperative complications, shorten hospital stays, and enhance overall patient outcomes across Korean healthcare institutions.

Citations

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Adapting Enhanced Recovery After Surgery for hepatobiliary and pancreatic surgery: a Korean perspective
Sang Hyun Shin
Ann Clin Nutr Metab.2026; 18(1): 1. CrossRef

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Development of a pre- and re-habilitation protocol for gastrointestinal cancer surgery: Eun Young Kim, Jung Hoon Bae, Jiseon Kim, Eun Joo Yang, Sang-Jae Park, In Kyu Lee, on behalf of the Task Force Team for Development and Trial Application of Pre/Rehabilitation Protocol in GI Cancer Surgery; Ann Clin Nutr Metab 2025;17(1):25-40. Published online April 1, 2025; DOI: https://doi.org/10.15747/ACNM.25.0001

Abstract PDF Supplementary Material: Purpose
Surgical resection is the primary curative treatment for gastrointestinal (GI) cancer; however, it is associated with high postoperative complication rates and impaired recovery. Frailty, malnutrition, and sarcopenia increase morbidity and mortality, underscoring the need for perioperative rehabilitation programs. Standardized rehabilitation protocols during the perioperative period are currently lacking in Korea. We aimed to develop an evidence-based rehabilitation protocol for GI cancer patients to enhance postoperative outcomes and facilitate clinical implementation.
Methods
A multidisciplinary task force team comprising experts in surgery, clinical nutrition, and rehabilitation medicine conducted a systematic literature search and comprehensive review from 2012 to 2022 to develop a standardized pre- and re-habilitation protocol for GI cancer surgery. The protocol underwent external validation and subsequent refinements before being finalized through expert consensus.
Results
The protocol development process was organized into four consecutive phases: keyword selection, literature review and case report form development, initial protocol drafting, and external validation leading to the final version of the protocol. The final version of the rehabilitation protocol is presented in the main text and included as Supplements.
Conclusion
This protocol provides a standardized clinical guideline based on the latest evidence-based pre- and re-habilitation strategies and is designed for seamless integration into routine clinical practice. By facilitating proactive rehabilitation interventions, it aims to improve outcomes in GI cancer patients who are at high risk of postoperative complications, functional decline, and malnutrition.

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The 2024 Korean Enhanced Recovery After Surgery guidelines for colorectal cancer: Kil-yong Lee, Soo Young Lee, Miyoung Choi, Moonjin Kim, Ji Hong Kim, Ju Myung Song, Seung Yoon Yang, In Jun Yang, Moon Suk Choi, Seung Rim Han, Eon Chul Han, Sang Hyun Hong, Do Joong Park, Sang-Jae Park, The Korean Enhanced Recovery After Surgery (ERAS) Committee within the Korean Society of Surgical Metabolism and Nutrition; Ann Clin Nutr Metab 2024;16(2):22-42. Published online August 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.2.22

Abstract PDF Supplementary Material

The Korean Enhanced Recovery After Surgery (ERAS) Committee within the Korean Society of Surgical Metabolism and Nutrition was established to develop ERAS guidelines tailored to the Korean context. This guideline focuses on creating the most current evidence-based practice guidelines for ERAS based on systematic reviews. All key questions targeted randomized controlled trials (RCTs) exclusively. If fewer than two RCTs were available, studies using propensity score matching were also included. Recommendations for each key question were marked with strength of recommendation and level of evidence following internal and external review processes by the committee.

Citations

Citations to this article as recorded by

Development of the Korean enhanced recovery after surgery audit program
Soo-Hyuk Yoon, Jae-Woo Ju, Ho-Jin Lee, Jeesun Kim, Min Jung Kim, Ji Won Park, Do Joong Park, Seung Yong Jeong
Scientific Reports.2025;[Epub] CrossRef
Optimizing postoperative pain management in minimally invasive colorectal surgery
Soo Young Lee
Annals of Coloproctology.2024; 40(6): 525. CrossRef

11,442 View
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2 Crossref

Perioperative Management of Morbidly Obese Patients during Major Abdominal Surgery: Byeong-Gon Na, Sang-Jae Park; Ann Clin Nutr Metab 2021;13(2):26-33. Published online December 31, 2021; DOI: https://doi.org/10.15747/ACNM.2021.13.2.26

Abstract PDF

The population with obesity is seeing a steady increase globally. Obesity is known to be associated with morbidity and mortality after major abdominal surgery, and this correlation becomes more prominent in morbidly obese (MO) patients. Accordingly, adequate preoperative evaluation and preparation should be performed with an understanding of the pathophysiological changes associated with the MO. Precise surgery and adequate postoperative management are also mandatory to reduce complications and unplanned readmissions. However, adequate guidelines for the perioperative management of MO patients undergoing major abdominal surgery are lacking. We provide an overview of the pathophysiologic changes and practical guidelines on the perioperative management of major abdominal surgery in MO patients.

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Spinal Anesthesia in Morbidly Obese Patients: Risks, Benefits, and Future Perspectives
T. K. Nematulloev, M. M. Matlubov
Innovative Medicine of Kuban.2025; 10(3): 99. CrossRef
FEATURES OF PREOPERATIVE MANAGEMENT FOR ABDOMINAL SURGERY IN OBESE PATIENTS
Sergii Khimich, Ihor Malyshevskyi, Olena Katelian
Актуальні проблеми сучасної медицини: Вісник Української медичної стоматологічної академії.2025; 25(3): 111. CrossRef
Multiplicative effect of frailty and obesity on postoperative mortality following spine surgery: a deep dive into the frailty, obesity, and Clavien-Dindo dynamic
Oluwafemi P. Owodunni, Evan N. Courville, Uchenna Peter-Okaka, Christian B. Ricks, Meic H. Schmidt, Christian A. Bowers
International Journal of Obesity.2024; 48(3): 360. CrossRef

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