<p>Introduction: Enhanced recovery after surgery (ERAS) is a well-established protocol to reduce perioperative stress, and hasten recovery. Its role in head and neck cancer surgery is relatively new, with consensus guidelines available for major head and neck cancer surgery requiring free flap surgery. In this study we looked at a modified ERAS protocol for major head and neck cancer surgery, with or without flap reconstruction, to determine feasibility, compliance and outcomes in a diverse, heterogenous patient cohort. Materials and methods: Retrospective evaluation of 160 consecutive patients undergoing major head and neck cancer surgery with or without reconstruction (defined as operating time over 3&#xa0;h, including radical oral cancer resections, laryngectomies, thyroidectomies with airway resection, and skull base resections). The modified ERAS protocol was applied to their care. Pre-operative, intra-operative and post-operative details and records were collected. Results: The modified ERAS protocol was well tolerated, and compliance rates for individual components ranged from 61 to 100%. The protocol was well suited for a diverse and heterogenous cohort of patients undergoing head and neck oncological surgery. Mortality was 3% and major morbidity was 13.75%, comparable to historical data. Aggressive post-operative rehabilitation resulted in a median stay of around 9 days; at discharge only 6.9% of patients had a feeding tube and 10% of patients had a tracheostomy. Conclusion: ERAS protocols are relevant, feasible and can have a high compliance rate when applied to a diverse cohort of surgeries in head and neck cancer. Although the broad tenets remain the same, minor modifications based on the setting are likely to improve compliance rates in countries like India where the health system is diverse and heterogenous. Continuous audit of patient outcomes and evaluation of best practices are necessary to improve morbidity and hasten recovery in patients with head and neck cancer.</p>