Enhanced Recovery after Surgery (ERAS) Program for Patients with Peritoneal Surface Malignancies Undergoing Cytoreductive Surgery with or without HIPEC: A Systematic Review and a Meta-Analysis

Abstract

Enhanced recovery after surgery (ERAS) program refers to a multimodal intervention to reduce the length of stay and postoperative complications; it has been effective in different kinds of major surgery including colorectal, gynaecologic and gastric cancer surgery. Its impact in terms of safety and efficacy in the treatment of peritoneal surface malignancies is still unclear. A systematic review and a meta-analysis were conducted to evaluate the effect of ERAS after cytoreductive surgery with or without HIPEC for peritoneal metastases. MEDLINE, PubMed, EMBASE, Google Scholar and Cochrane Database were searched from January 2010 and December 2021. Single and double-cohort studies about ERAS application in the treatment of peritoneal cancer were considered. Outcomes included the postoperative length of stay (LOS), postoperative morbidity and mortality rates and the early readmission rate. Twenty-four studies involving 5131 patients were considered, 7 about ERAS in cytoreductive surgery (CRS) + HIPEC and 17 about cytoreductive alone; the case histories of two Italian referral centers in the management of peritoneal cancer were included. ERAS adoption reduced the LOS (−3.17, 95% CrI −4.68 to −1.69 in CRS + HIPEC and −1.65, 95% CrI −2.32 to –1.06 in CRS alone in the meta-analysis including 6 and 17 studies respectively. Non negligible lower postoperative morbidity was also in the meta-analysis including the case histories of two Italian referral centers. Implementation of an ERAS protocol may reduce LOS, postoperative complications after CRS with or without HIPEC compared to conventional recovery.

Effectiveness of general anaesthesia with remimazolam tosilate on intraoperative haemodynamics and postoperative recovery: study protocol for a randomised, positive-controlled, pragmatic clinical trial (GARTH trial)

“…Recently, many studies reported the effectiveness of ERAS across surgical procedures mainly evaluated by doctor-reported outcomes and length of hospital stay 2–4. However, new information is necessary for better uncovering the value of ERAS on patients receiving surgeries, such as the advance of anaesthetic drugs and the availability of implemented tool to assess patient-reported outcomes, as the ERAS Society guideline recommended 5 6. A variety of patient-reported outcomes, such as postoperative quality of recovery (QoR) or the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), have currently been used to measure the impact of ERAS, alongside conventional doctor-reported outcomes and length of hospital stay 7–9…”

Enhanced Recovery after Surgery (ERAS) in Postoperative Lung Cancer Patients: A Novel Perioperative Strategy for Preventing Venous Thromboembolism and Improving Quality of Life

“…In 1999, Kehlet H et al discovered of ERAS (Kehlet and Wilmore 2008). The key elements of ERAS program include patient and family education and counseling, patient optimization prior to admission, minimal fasting (light meal up to six hours before surgery, carbohydrate beverage two hours before anesthesia), multimodal analgesia with appropriate use of opioids, nausea and vomiting prophylaxis, early nutrition and mobilization (Robella et al 2023). Hospital stays and immobilization, as risk factors for VTE, are reduced by ERAS (Cho et al 2022).…”

Implementation of an Enhanced Recovery after Surgery Protocol in Advanced and Recurrent Rectal Cancer Patients after beyond Total Mesorectal Excision Surgery: A Feasibility Study

“…Due to the increasing level of experience with ERAS principles in colorectal surgery, it seemed the appropriate time to apply the ERAS principles to advanced rectal cancer surgery. In several high-expertise fields, such as upper gastro-intestinal surgery and cytoreductive surgery with hyperthermal intraperitoneal chemotherapy, ERAS implementation has seemed promising, with good postoperative results [7,[11][12][13]. Therefore, a tailored ERAS protocol for locally advanced and recurrent rectal cancer (LARRC) has been developed by a multidisciplinary team with expertise in advanced rectal cancer [10].…”