Enhanced Recovery After Surgery (ERAS) in Surgical Oncology

Ripollés‐Melchor, Javier; Abad‐Motos, Ane; Zorrilla‐Vaca, Andrés

doi:10.1007/s11912-022-01282-4

Cited by 12 publications

(5 citation statements)

References 105 publications

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“…ERAS is a new model of care based on evidence-based medicine, consisting of surgery, nursing, anesthesia, rehabilitation, nutrition, and other disciplines, which aims to reduce the length of hospital stay and postoperative complications by reducing the stress response caused by surgical trauma, thereby facilitating rapid patient recovery ( 46 ). The effectiveness of ERAS was initially demonstrated in colorectal surgery and then widely used in urology for radical cystectomy and radical prostatectomy with favorable results.…”

Section: Discussionmentioning

confidence: 99%

Application of enhanced recovery after surgery in partial nephrectomy for renal tumors: A systematic review and meta-analysis

Tianyi²,

Ma³

et al. 2023

Front. Oncol.

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ObjectivesIn recent years, enhanced recovery after surgery (ERAS) has been widely used in the field of urology, especially in radical cystectomy and radical prostatectomy, and has demonstrated its advantages. Although studies on the application of ERAS in partial nephrectomy for renal tumors are increasing, the conclusions are mixed, especially in terms of postoperative complications, etc, and its safety and efficacy are questionable. We conducted a systematic review and meta-analysis to assess the safety and efficacy of ERAS in the application of partial nephrectomy for renal tumors.MethodsPubmed, Embase, Cohrance library, Web of science and Chinese databases (CNKI, VIP, Wangfang and CBM) were systematically searched for all published literature related to the application of enhanced recovery after surgery in partial nephrectomy for renal tumors from the date of establishment to July 15, 2022, and the literature was screened by inclusion/exclusion criteria. The quality of the literature was evaluated for each of the included literature. This Meta-analysis was registered on PROSPERO (CRD42022351038) and data were processed using Review Manager 5.4 and Stata 16.0SE. The results were presented and analyzed by weighted mean difference (WMD), Standard Mean Difference (SMD) and risk ratio (RR) at their 95% confidence interval (CI). Finally, the limitations of this study are analyzed in order to provide a more objective view of the results of this study.ResultsThis meta-analysis included 35 literature, including 19 retrospective cohort studies and 16 randomized controlled studies with a total of 3171 patients. The ERAS group was found to exhibit advantages in the following outcome indicators: postoperative hospital stay (WMD=-2.88, 95% CI: -3.71 to -2.05, p<0.001), total hospital stay (WMD=-3.35, 95% CI: -3.73 to -2.97, p<0.001), time to first postoperative bed activity (SMD=-3.80, 95% CI: -4.61 to -2.98, p < 0.001), time to first postoperative anal exhaust (SMD=-1.55, 95% CI: -1.92 to -1.18, p < 0.001), time to first postoperative bowel movement (SMD=-1.52, 95% CI: -2.08 to -0.96, p < 0.001), time to first postoperative food intake (SMD=-3.65, 95% CI: -4.59 to -2.71, p<0.001), time to catheter removal (SMD=-3.69, 95% CI: -4.61 to -2.77, p<0.001), time to drainage tube removal (SMD=-2.77, 95% CI: -3.41 to -2.13, p<0.001), total postoperative complication incidence (RR=0.41, 95% CI: 0.35 to 0.49, p<0.001), postoperative hemorrhage incidence (RR=0.41, 95% CI: 0.26 to 0.66, p<0.001), postoperative urinary leakage incidence (RR=0.27, 95% CI: 0.11 to 0.65, p=0.004), deep vein thrombosis incidence (RR=0.14, 95% CI: 0.06 to 0.36, p<0.001), and hospitalization costs (WMD=-0.82, 95% CI: -1.20 to -0.43, p<0.001).ConclusionERAS is safe and effective in partial nephrectomy of renal tumors. In addition, ERAS can improve the turnover rate of hospital beds, reduce medical costs and improve the utilization rate of medical resources.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO, identifier CRD42022351038.

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Section: Discussionmentioning

confidence: 99%

Application of enhanced recovery after surgery in partial nephrectomy for renal tumors: A systematic review and meta-analysis

Tianyi²,

Ma³

et al. 2023

Front. Oncol.

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“…In addition, the ERAS protocol may further increase the general level of informational need. ERAS is a perioperative bundled multimodal strategy that includes nutrition optimization, standardized analgesic and anesthetic regimens, and early mobilization, with the ultimate goal of reducing surgical stress, improving clinical outcomes, and reducing length of hospitalization (Ripollés-Melchor, Abad-Motos, & Zorrilla-Vaca, 2022). With shorter hospital stays and more intensive treatment, adequate perioperative information counseling is key to ensuring patient compliance and medical safety.…”

Section: Discussionmentioning

confidence: 99%

Supportive Care Needs of Patients With Temporary Ostomy in Enhanced Recovery After Surgery: A Mixed-Methods Study

HU,

ZHANG,

SUN

et al. 2024

Journal of Nursing Research

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Background Enhanced recovery after surgery (ERAS), a global surgical quality improvement initiative, reduces the length of stay in the hospital. Temporary stoma care for rectal cancer is complex, and patients require prolonged care services to adjust to the stoma. The shorter stay durations in the new model challenge the conventional care pathways and create new patient needs. Purpose This study was designed to explore the supportive care needs of patients under the new surgical model to provide a reference for the design of ERAS nursing care plans. Methods A convergent parallel mixed-methods design was used in this study. Patients with temporary stomas for rectal cancer were recruited using a convenience sampling method in gastrointestinal surgery wards and wound & stoma clinics in two public tertiary care hospitals in China. Standardized questionnaires were administered to 140 patients to collect quantitative data, and semistructured interviews were conducted individually with 13 patients to collect qualitative data. The questionnaire data were analyzed using descriptive statistics, and the interview data were analyzed using thematic analysis. Results “Health system and information needs” and “care and support needs” were identified in both the qualitative and quantitative analyses as the most significant unmet needs of the participants. In addition, the qualitative analysis identified receiving focused stoma care instructions and easily understandable information as essential to fulfilling health system and information needs. Care and support needs included access to continued postdischarge services and attention from medical professionals. Conclusion/Implications for Practice The participants in this study experienced a variety of unmet supportive care needs under the ERAS protocol, with gaps particularly notable in two categories: “health system and information needs” and “care and support needs.” Increased perioperative care and shorter hospital stays under the ERAS protocol reduce opportunities for patients to receive targeted instruction and shift much of the ostomy education and care workload out of the hospital, requiring greater attention from clinical nurses to ensure quality of care.

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“…However, the specific impact of each of these components on clinical outcomes is still unknown. There is very scarce evidence available on the influence of these items on outcomes in cancer[ 20 ].…”

Section: There Is a Range Of Limitations That Mitigate The Effectiven...mentioning

confidence: 99%

Does enhanced recovery after surgery programs improve clinical outcomes in liver cancer surgery?

Sánchez-Pérez,

Ramia

2024

World J Gastrointest Oncol

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Enhanced recovery after surgery (ERAS) programs have been widely applied in liver surgery since the publication of the first ERAS guidelines in 2016 and the new recommendations in 2022. Liver surgery is usually performed in oncological patients (liver metastasis, hepatocellular carcinoma, cholangiocarcinoma, etc. ), but the real impact of liver surgery ERAS programs in oncological outcomes is not clearly defined. Theoretical advantages of ERAS programs are: ERAS decreases postoperative complication rates and has been demonstrated a clear relationship between complications and oncological outcomes; a better and faster postoperative recovery should let oncologic teams begin chemotherapeutic regimens on time; prehabilitation and nutrition actions before surgery should also improve the performance status of the patients receiving chemotherapy. So, ERAS could be another way to improve our oncological results. We will discuss the literature about liver surgery ERAS focusing on its oncological implications and future investigations projects.

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Enhanced Recovery After Surgery (ERAS) in Surgical Oncology

Cited by 12 publications

References 105 publications

Application of enhanced recovery after surgery in partial nephrectomy for renal tumors: A systematic review and meta-analysis

Application of enhanced recovery after surgery in partial nephrectomy for renal tumors: A systematic review and meta-analysis

Supportive Care Needs of Patients With Temporary Ostomy in Enhanced Recovery After Surgery: A Mixed-Methods Study

Does enhanced recovery after surgery programs improve clinical outcomes in liver cancer surgery?

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