Accelerated Rehabilitation Surgery (ERAS) adopts a series of perioperative management measures with evidence-based medical evidence to reduce the physical and psychological traumatic stress of surgical patients and achieve rapid recovery. This is a new concept and treatment and rehabilitation mode in the 21st century medicine, and the benefits of ERAS are reflected in: (1) improving treatment effect; (2) reducing postoperative complications; (3) accelerating patients’ recovery; (4) shortening hospitalization time; (5) lowering medical costs; and (6) reducing the burden on the society and the family. In clinical practice, ERAS is currently most successfully used in colorectal surgery. Now, according to the results of clinical research and experts’ experience, combined with the ERAS program for colorectal surgery in the literature, the Chinese Expert Consensus on the Application of Accelerated Rehabilitation Surgery for Colorectal Surgery (2015 Edition) is formed. 1, Preoperative assessment and publicity and education Preoperative assessment of patients’ surgical risk and tolerance, and strengthening publicity and education will be conducive to postoperative recovery. Focusing on the treatment process and surgical program, it is easy for patients to cooperate with the postoperative rehabilitation and early discharge program, especially letting patients understand the important role they play in this program, including early feeding and early getting out of bed activities after surgery. 2, Preoperative Bowel Preparation Routine preoperative bowel preparation is a stressful stimulus for patients and may lead to dehydration and electrolyte imbalance, especially in elderly patients. The results of meta-analysis showed that bowel preparation is not beneficial for patients undergoing colorectal surgery and may also increase the risk of postoperative intestinal anastomotic fistula [14]. Therefore, routine preoperative bowel preparation is not advocated for patients undergoing colorectal surgery, and preoperative bowel preparation is suitable for patients who need intraoperative colonoscopy or have severe constipation. 3, preoperative fasting and drinking There is no evidence to support the traditional colorectal surgery before too long fasting can avoid reflux aspiration. Now the anesthesia societies of many countries recommend that for those without gastrointestinal dysfunction, solid diet is allowed before 6h of anesthesia, and clear liquid food is allowed before 2h. Drinking 800mL 12h before surgery and 400mL of clear carbohydrate drink 2-3h before surgery can reduce the symptoms of preoperative thirst, hunger and irritability of patients, and significantly reduce the incidence of postoperative insulin resistance; it puts the patients in a more appropriate metabolic state and reduces the occurrence of postoperative hyperglycemia and complications. 4, preoperative anesthesia medication Except for special patients, routine preoperative anesthesia medication (sedation and anticholinergics) is not recommended. For nervous patients, short-acting anxiolytics may be helpful when placing an epidural catheter. 5, prophylactic antibiotic use in colon surgery prophylactic use of antibiotics is conducive to reducing infections, but need to pay attention to: (1) prophylaxis should be included in both aerobic and anaerobic bacteria; (2) in the incision of the skin 30min before the use of; (3) single-dose prophylaxis and multi-dose program has the same effect, if the duration of the operation > 3h, you can repeat the dose once in the operation. 6.Anesthesia regimen General anesthesia, epidural block, general anesthesia combined with epidural block and other anesthesia regimens can be used. Mid-thoracic epidural block is beneficial to inhibit the stress response, reduce intestinal paralysis, facilitate rapid postoperative awakening, good postoperative analgesia, and promote the recovery of intestinal function. Rectal surgery encourages the application of minimally invasive techniques, such as laparoscopy and robotic surgery system. The application of ERAS in open colon surgery also achieves better results and should not be ignored. 8, Placement of gastro-nasal tube Nasogastric tube decompression should not be routinely placed in colorectal surgery, which can reduce the incidence of postoperative fever, pulmonary atelectasis and pneumonia. If gas enters the stomach during tracheal intubation, a gastric tube can be inserted to expel the gas, but it should be removed before the patient is awake from anesthesia. Therefore, routine use of a nasogastric tube for postoperative decompression is not recommended. There is a risk of reflux and aspiration with the administration of fluids through a nasogastric tube. Domestic and international experience has shown that giving pectin-based dietary fiber can reduce such adverse reactions. Avoid intraoperative hypothermia. Avoiding intraoperative hypothermia can reduce the effects on neuroendocrine metabolism and coagulation mechanism. It is recommended to routinely monitor the body temperature and adopt necessary thermal insulation measures, such as covering thermal blankets, liquid and gas warming. 10.Perioperative fluid therapy Recent research results show that reducing the amount of intraoperative and postoperative fluid and sodium salt input will be beneficial to reducing the occurrence of postoperative complications in patients, accelerating the recovery of gastrointestinal function, and shortening postoperative hospitalization time [9-10]. Intraoperative restrictive volume therapy strategy based on goal orientation is the best method to reduce perioperative fluid overload and cardiopulmonary overload. The use of epidural anesthesia may cause vasodilation, leading to a relative lack of intravascular volume and hypotension. Therefore, hypotension due to vasodilatation is managed by the use of vasoconstrictors rather than by massive fluid infusion. In high-risk patients, intraoperative monitoring using transesophageal ultrasound Doppler examination can help titrate fluid requirements. 11, Abdominal Drainage Place an abdominal drain because the pain factor will interfere with the patient’s early movement out of bed. The use of an abdominal drain after colonic anastomosis does not reduce the incidence or severity of anastomotic fistula and other complications. Therefore, routine placement of an abdominal drain is not recommended for colectomy. Urethral drainage Placement of a urinary catheter will also affect the patient’s early postoperative activity. In patients undergoing colon resection using epidural analgesia, the risk of urinary retention is low after 24 h of catheterization. Therefore, it is recommended that catheter removal should be considered after 24h of catheter use during epidural analgesia in the thoracic segment. In contrast, in the case of transabdominal low anterior resection of the rectum, the catheter is placed for about 2d. 13, postoperative nausea, vomiting treatment In order to be able to early oral feeding need to effectively deal with postoperative nausea, vomiting symptoms. Drugs that may cause vomiting, such as neostigmine and opioids, should be avoided in favor of other drugs with fewer adverse effects. Antiemetics such as ondansetron and dexamethasone should be used prophylactically in patients at risk of vomiting. The above drugs can be used in combination if the patient experiences nausea and vomiting. Prevention of intestinal paralysis and promotion of gastrointestinal motility Attention should be paid to the prevention and treatment of postoperative intestinal paralysis, including the use of epidural analgesia, avoidance or reduction of the use of opioid analgesics, avoidance of excessive fluid intake, and the early resumption of oral intake, etc. The prevention and treatment of postoperative intestinal paralysis should be emphasized. Oral laxatives such as lactulose should be taken from the night before surgery and early postoperative period. Postoperative analgesia Postoperative analgesia is the core content of ERAS. Adequate postoperative analgesia can reduce stress and facilitate the patient’s recovery.ERAS postoperative analgesia advocates a multimodal analgesic program. The important principle of analgesia is that nonsteroidal anti-inflammatory drugs (NSAIDs) are the basic drugs for postoperative analgesia, and the application of opioids is minimized to reduce opioid-induced complications such as intestinal paralysis and to promote the early recovery of the patient.COX-1 and COX-2 functionally overlap and complement each other. complementarity together to exert a protective effect on the body. Preoperative use of NSAIDs to prevent analgesia may improve postoperative analgesia and accelerate the recovery of patients. Postoperative nutritional therapy There is no evidence that postoperative fasting is beneficial when comparing early enteral nutrition or oral diet with postoperative fasting after gastrointestinal surgery. Early enteral ___ nutrition can reduce the incidence of postoperative infection and shorten the postoperative hospitalization time, and enteral nutrition at the proximal end of the anastomosis does not increase the risk of enteroanastomotic fistula. However, early enteral nutrition may increase the incidence of vomiting in patients. In the absence of multimodal anti-enteric paralytic therapy, early enteral nutrition may increase intestinal distention, and affect the patient’s early mobility and impair lung function. Therefore, it is necessary to enhance the comprehensive treatment of postoperative intestinal paralysis, which facilitates the implementation of early postoperative feeding. In conventional treatment, oral adjuvant nutrition is often started only 4-5d postoperatively; whereas in the ERAS program, oral nutrition is started before surgery as well as 4h postoperatively. The results of one study have shown that when preoperative oral carbohydrates, epidural analgesia and early enteral nutrition are used in combination, they can promote patients’ nitrogen balance and reduce the incidence of postoperative hyperglycemia [5]. The importance of multimodal therapy to maintain surgical nutritional status needs to be emphasized, and patients should be encouraged to eat orally at 4h postoperatively, with the amount of food gradually increased according to gastrointestinal tolerance. For malnourished patients should continue to take oral adjuvant nutrients after going home. 17, early postoperative bed activities Long-term bed rest not only increases insulin resistance and muscle loss, but also reduces muscle strength, impairs lung function and tissue oxygenation, and also increases the risk of venous thrombosis of the lower extremities. Postoperative analgesia can be well performed with a portable thoracic segmental epidural analgesia pump or with routine use of NSAIDs, which is an important guarantee to promote early patient activity. The patient’s activity level is planned and implemented on a daily basis according to the patient’s objective condition and an activity diary is established for the patient. The goal is to get out of bed on the first day after surgery for 1~2h, and then to get out of bed for 4~6h per day until the time of discharge. Discharge criteria Resume eating solid food without intravenous rehydration; Oral painkillers can provide good analgesia; Free to move to the bathroom. Patients should be discharged when they meet all the above requirements and are willing to be discharged. The identified discharge indications should be fully complied with. 19, follow-up and outcome assessment All good surgical practice relies on good monitoring and summarization of clinical outcomes, which is not only conducive to the control of complications and morbidity and mortality, but also conducive to feedback on the research program and summarize information for improvement and education. The results of some studies have found that the rehospitalization rate of patients who underwent ERAS program is about 10% to 20% when the length of stay is shortened to 2-3d, and a very small number of patients are likely to develop anastomotic fistula after discharge [15]. Therefore, patient follow-up should be strengthened and a clear “green channel” for readmission should be established. Telephone follow-up and guidance should be provided within 24-48 h after discharge, and outpatient visits should be conducted 7-10 d after surgery, such as wound debridement, discussion of pathology results, and planning for further antitumor therapy. In general, the clinical follow-up of ERAS should last at least until 30d postoperatively.