Maria Bourazani, Chrysseida Maglari, Antonios Anagnostopoulos, Nikolaos Fyrfiris
Enhanced Recovery After Surgery (ERAS) pathways are evidence-based, multimodal approaches to perioperative care designed to reduce surgical stress, standardize clinical practice, and promote earlier functional recovery. In gynecologic oncology, their clinical benefits are well established; however, successful implementation remains challenging because of surgical complexity, variation in institutional resources, inconsistent adherence to protocol elements, and the need for coordinated multidisciplinary care. This narrative review examines the practical implementation of ERAS pathways in gynecologic oncology, with emphasis on the translation of contemporary recommendations into routine clinical practice. Particular attention is given to multidisciplinary coordination, nursing roles, protocol adherence, patient engagement, organizational barriers, and long-term sustainability. Current evidence indicates that formal adoption of an ERAS pathway does not necessarily ensure consistent delivery of its individual components, while greater adherence is associated with improved postoperative outcomes. Nursing professionals have a central role in ERAS implementation because they contribute to continuity of care across the perioperative pathway through patient education, symptom assessment, mobilization, nutritional support, recovery monitoring, and discharge preparation. Effective implementation also requires clearly defined professional responsibilities, structured communication, patient participation, and mechanisms for identifying clinically justified deviations from unwarranted variation in practice. ERAS should therefore be regarded not as a static checklist but as a dynamic, multidisciplinary clinical system. Sustainable integration into gynecologic oncology practice depends on evidence-based standardization, appropriate individualization, active nursing and patient participation, and ongoing monitoring of adherence and outcomes.