The impact of Enhanced Recovery after Surgery (ERAS) pathways with regard to perioperative outcome in patients with ovarian cancer

Abstract

Purpose Major surgery for ovarian cancer is associated with significant morbidity. Recently, guidelines for perioperative care in gynecologic oncology with a structured “Enhanced Recovery after Surgery (ERAS)” program were presented. Our aim was to evaluate if implementation of ERAS reduces postoperative complications in patients undergoing extensive cytoreductive surgery for ovarian cancer. Methods 134 patients with ovarian cancer (FIGO I-IV) were included. 47 patients were prospectively studied after implementation of a mandatory ERAS protocol (ERAS group) and compared to 87 patients that were treated before implementation (pre-ERAS group). Primary endpoints of this study were the effects of the ERAS protocol on postoperative complications and length of stay in hospital. Results Preoperative and surgical data were comparable in both groups. Only the POSSUM score was higher in the ERAS group (11.8% vs. 9.3%, p < 0.001), indicating a higher surgical risk in the ERAS group. Total number of postoperative complications (ERAS: 29.8% vs. pre-ERAS: 52.8%, p = 0.011), and length of hospital stay (ERAS: 11 (6–23) vs pre-ERAS: 13 (6–50) days; p < 0.001) differed significantly. A lower fraction of patients of the ERAS group (87.2%) needed postoperative admission to the ICU compared to the pre-ERAS group (97.7%), p = 0.022). Mortality within the ERAS group was 0% vs. 3.4% (p = 0.552) in the pre-ERAS group. Conclusion The implementation of a mandatory ERAS protocol was associated with a lower rate of postoperative complications and a reduced length of stay in hospital. If ERAS has influence on long-term outcome needs to be further evaluated.

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

“…The effects of ERAS have been extensively investigated in standard surgical settings, including colorectal and gynecological surgery [41,42]. Its application is slowly spreading even to more complex and particular interventions such as those for peritoneal metastases [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][35][36][37][38][39][40] and guidelines for perioperative care in CRS with or without HIPEC have recently been published by the ERAS Society detailing the benefits of each item of the pathway [43,44]. This is the first meta-analysis concerning the application of the ERAS program focused on patients suffering from peritoneal disease of various origins and subjected to heterogeneous surgical procedures.…”

Risk factors of perioperative complications and management with enhanced recovery after primary surgery in women with epithelial ovarian carcinoma in a single center

“…Patients with ovarian carcinoma are distinctly different from other gynecological surgical patients. Although ERAS has been used for colorectal malignancies and other surgical tumors, only a few relevant published studies are available on the ERAS protocols due to the heterogeneity of ovarian cancer (75)(76)(77)(78)(79)(80). At the time of diagnosis, the patients often have an advanced stage disease with complex symptoms, including abdominal distension, dyspnea, impairment of gastrointestinal function and malnutrition, which require aggressive cytoreductive procedures such as multivisceral resections; patients also are prone to a high risk of postoperative morbidity.…”

Postoperative paralytic ileus following debulking surgery in ovarian cancer patients

“…The most powerful therapeutic tool is optimal cytoreduction to no residual disease, usually requiring high surgical complexity and harboring the risk of increased morbidity (2)(3)(4)(5)(6). While enhanced recovery after surgery (ERAS) programs in colorectal and ovarian cancer surgery showed lower morbidity and mortality, no effect was seen on the frequency of postoperative paralytic ileus (POI) (7)(8)(9)(10).…”