Enhanced Recovery After Surgery Impact on the Systemic Inflammatory Response of Patients Following Gynecological Oncology Surgery: A Prospective Randomized Study

Abstract

Objective Enhanced recovery after surgery (ERAS) protocol has widely gained acceptance in gynecological surgery. Its safety and efficacy should be evaluated fully via well-designed, randomized, control trials. The main objective of our study is to compare the ERAS protocol with the conventional perioperative care program after gynecological oncology. Furthermore, the secondary objectives of our study are the identification of markers that allow us to evaluate the effectiveness of the application of ERAS elements in the modulation of the body’s response to surgical stress. Methods Patients with gynecological tumors indicated for surgery were randomly assigned to either the ERAS group or the conventional group. The ERAS protocol included short fasting time, fluid restriction, early oral feeding, reduced opioid consumption and immediate mobilization after surgery. The primary endpoint was the reduction of hospital stay in the ERAS group. The day of first flatus, postoperative nausea and vomiting (PONV), maximum pain score by the visual analogue scale (VAS) and complication, readmission rate, reoperation rate, postoperative mortality, total hospital cost and systemic inflammatory response (SIR) were secondary endpoints. Results A total of 130 patients in gynecological tumor surgery were enrolled (ERAS = 65, conventional = 65). The ERAS group had faster bowel function recovery, significantly less pain, less PONV, shorter hospital stay, and less total hospital costs. SIR markers were estimated and screened out that postoperative platelet, neutrophil-lymphocyte-ratio (NLR) and platelet-lymphocyte-ratio (PLR) were significantly lower in ERAS groups compared to conventional groups. Conclusion The implementation of ERAS protocol is safe and enhances postoperative recovery after gynecological oncology surgery. We firstly reveal the beneficial effect of ERAS protocols on the alleviation of postoperative SIR, which is a reflection of the magnitude of surgical trauma. Postoperative platelet, NLR or PLR could be the novel and inexpensive markers to assess how ERAS protocols modulate gynecological oncology surgery. Trial Registration The trial was registered in ClinicalTrials.gov (NCT03629626).

Enhanced recovery after gynecological surgery: comparison between intrathecal and intravenous morphine multimodal analgesia

“…according to gynecological surgery guidelines, multimodal analgesia combined with eras protocols resulted in reduced opioid consumption, less postoperative nausea and vomiting (PONV) and earlier discharge times, reducing healthcare costs. [4][5][6][7][8][9] the aim of the present study was to compare the efficacy of intrathecal morphine (IM) injection as part of multimodal intravenous analgesia protocols with prophylaxis of postoperative nausea and vomiting versus intravenous patient-controlled analgesia (Pca) in women undergoing to two different gynecological surgical approaches: laparoscopic hysterectomy or laparotomic myomectomy. the dose-sparing effect of intravenous rescue analgesics, the intensity of postoperative pain, side effects and length of hospitalization were evaluated.…”

“…1,2 surgical acute pain is a modifiable risk factor for the develop-ment of chronic postoperative pain and is a key component of enhanced recovery after surgery (eras) protocols. 3,4 Multimodal analgesia, i.e., the administration…”

Commentary: Preoperative neutrophil to lymphocyte ratio predicts complications after esophageal resection that can be used as inclusion criteria for enhanced recovery after surgery

“…Such experimental results show that the systemic inflammatory response in the ERAS group was significantly inhibited by the perioperative ERAS protocol. In the study by Peng et al (8), the ERAS protocol was used in gynecological surgery. A total number of 130 surgical patients with gynecologic tumors were included in this study.…”

Role of transumbilical laparoendoscopic single-site surgery in the implementation of ERAS in gynecology oncology: a retrospective study

“…The Enhanced Recovery After Surgery (ERAS) pathway was designed to improve the recovery of surgical patients through the preoperative, operative, and postoperative stages [1]. This evidence-based protocol provides active strategies to minimize the stress of surgery, reduce postoperative complications, decrease hospital stay, and facilitate improved functional recovery [2,3].…”

“…Morbidity associated with surgery affects patient outcomes, quality of life, and survival rates [4]. Although most investigations of ERAS protocols are implemented in open surgery, patients who undergo laparoscopic surgery can also benefit from following the ERAS protocols, according to multiple studies [1]. Numerous reports have demonstrated that operative and post-operative complications can interfere with overall survival rate [4].…”