Enhanced Recovery Pathways in Head and Neck Cancer Surgery: Recovery and Safety in an Updated Meta-analysis.

BACKGROUND

This study aimed to evaluate postoperative recovery, analgesic use, complications, and short-term safety of multicomponent enhanced recovery after surgery (ERAS) pathways versus conventional care after head and neck cancer surgery.

METHODS

PubMed, Embase, and Web of Science were searched through 22 July 2026. Comparative studies were synthesized using restricted maximum-likelihood random-effects models. Hospital length of stay was the primary outcome. Procedure-stratified and sensitivity analyses were performed, and certainty was assessed using GRADE.

RESULTS

The meta-analysis included 15 studies involving 2787 patients. The ERAS approach was associated with shorter hospital stay (13 studies; mean difference [MD], - 2.75 days; 95% confidence interval [CI], - 4.16 to - 1.35 days), earlier enteral feeding (4 studies; MD, - 1.49 days; 95% CI, - 1.96 to 1.01 days), and lower 72-h opioid consumption (3 studies; MD, - 55.98 mg morphine milligram equivalents [MMEs]; 95% CI, - 70.89 to - 41.07 MMEs). No clear differences were observed in 30-day readmission, total flap failure, reoperation, or 30-day mortality. Overall complications were model dependent, and no significant interaction by surgical approach was detected. Evidence certainty was low for hospital stay, enteral feeding, and opioid consumption and very low for the remaining outcomes.

CONCLUSIONS

The ERAS approach may improve recovery efficiency and reduce early opioid requirements after head and neck cancer surgery. Evidence for major complications and short-term safety remains uncertain.