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- HOME > Ann Clin Nutr Metab > Volume 18(1); 2026 > Article
- Editorial Adapting Enhanced Recovery After Surgery for hepatobiliary and pancreatic surgery: a Korean perspective
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Sang Hyun Shin
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Annals of Clinical Nutrition and Metabolism 2026;18(1):1-2.
DOI: https://doi.org/10.15747/ACNM.26.0043
Published online: March 30, 2026
Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Corresponding author: Sang Hyun Shin, e-mail: surgeonssh@skku.edu
• Received: March 3, 2026 • Accepted: March 3, 2026
© 2026 The Korean Society of Surgical Metabolism and Nutrition · The Korean Society for Parenteral and Enteral Nutrition · Asian Society of Surgical Metabolism and Nutrition
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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In the previous issue, Hong et al. [1] presented Korean-adapted Enhanced Recovery After Surgery (ERAS) guidelines for hepatobiliary and pancreatic (HBP) surgery. ERAS has evolved substantially since the study group was founded in London in 2001, and the first colorectal guideline was published in 2005 [2]. International ERAS guidelines are now available for both pancreatoduodenectomy and hepatectomy [3,4]. However, anyone who has tried to apply them in the Korean context recognizes the considerable gap between theory and practice. Our patients tend to be leaner, our hospital stays are structured differently, and certain perioperative practices reflect traditional habits rather than evidence-based recommendations. A protocol developed around European cohorts does not always translate well to Korea, which is why a Korean adaptation was long overdue.
What is most notable about these guidelines is the process used to develop them. Rather than beginning with a simple literature review, the committee referred to a prior survey of Korean HBP surgeons to identify areas of genuine disagreement in clinical practice [5]. They then focused specifically on those controversial issues. This is a pragmatic strategy, and it is clearly reflected in the final recommendations. Among the 12 key questions, several recommendations directly challenge long-standing practices: avoiding routine drainage after uncomplicated hepatectomy [6], not using nasogastric tubes after pancreaticoduodenectomy [7], and applying a risk-stratified strategy for perianastomotic drain management based on the Fistula Risk Score and postoperative day 1 amylase levels [8]. The evidence supporting these recommendations is strong. However, whether they will truly change everyday practice in the ward setting is another question.
For readers of this journal, the nutritional aspects also deserve closer attention. Patients scheduled for pancreatic surgery often present in a malnourished state, with weight loss due to the tumor itself, decreased oral intake caused by biliary obstruction, and sometimes several weeks of reduced appetite that may not have been properly documented. The guidelines recommend screening with the Nutrition Risk Screening 2002 or the Patient-Generated Subjective Global Assessment and initiating nutritional support, which contributes to reduced postoperative complications and shorter hospital stays [9,10]. These measures may sound straightforward, but in real-world clinical settings, they require close coordination among surgeons, dietitians, and sometimes gastroenterologists, and many multidisciplinary teams have not yet fully established such collaboration. Despite these challenges, proper nutritional support before surgery is just as important as the surgery itself.
Once published, guidelines can easily remain on paper. The real work, including building multidisciplinary teams, auditing compliance, and providing feedback to frontline clinicians, begins only afterward. The Korean ERAS guidelines for HBP surgery provide a credible and locally relevant framework. Ultimately, their impact depends on how effectively we put them into practice.
Authors’ contribution
All work was done by Sang Hyun Shin.
Conflict of interest
Sang Hyun Shin has served as the editor of the Annals of Clinical Nutrition and Metabolism since 2021. However, he was not involved in the peer review process or decision-making regarding publication. Otherwise, no potential conflict of interest relevant to this article was reported.
Funding
None.
Data availability
Not applicable.
Acknowledgments
None.
Supplementary materials
None.
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- 8. McMillan MT, Malleo G, Bassi C, Allegrini V, Casetti L, Drebin JA, et al. Multicenter, prospective trial of selective drain management for pancreatoduodenectomy using risk stratification. Ann Surg 2017;265:1209-18. ArticlePubMed
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