Where Enhanced Recovery after Surgery (ERAS) Protocols Meet the Three Major Current Pandemics: COVID-19, Obesity and Malignancy

Abstract

The outbreak of the SARS-CoV-2 (COVID-19) pandemic has transformed the provision of medical services for both patients that receive care for COVID-19 and for those that need care either for benign diseases, including obesity, or for malignancies, such as gynecological cancer. In this perspective article, we focus on the association among three major worldwide health issues and how ERAS protocols can potentially provide optimal management of patients with obesity and malignancy during the COVID-19 pandemic, with special attention to patients who required surgery for gynecologic oncology. A thorough search of the literature on the respective topics was performed. Patients with malignancy and obesity presented with increased vulnerability to COVID-19 infection. However, the management of their disease should not be withheld. Protective measures should be established to reduce exposure of patients with oncological diseases to SARS-CoV-2 while simultaneously enabling their access to vaccination. Since ERAS protocols have proved to be efficient in many surgical fields, including gynecologic oncology, general surgery, and orthopedics, we strongly believe that ERAS protocols may play a significant role in this effort. The end of the COVID-19 pandemic cannot be accurately predicted. Nevertheless, we have to ensure the appropriate and efficient management of certain groups of patients.

Enhanced Recovery After Surgery Protocols in Obese Gynecological Oncology Patients: A Single-Center Experience

“…Furthermore, one should take into consideration that a further delay to apply a prehabilitation program could potentially lead to disease progression and worse oncologic outcomes. However, active prehabilitation protocols [ 26 ] without postponing the surgical treatment could be a beneficial option during the recently increasing delays in cancer treatments in the COVID-19 era [ 27 , 28 ].…”

Perspectives and Challenges of COVID-19 with Obesity-Related Cancers

“…Apart from the abovementioned therapeutic approaches in oncologic patients during the COVID-19 pandemic, special attention must be given to patients who need oncological surgery because of the modification of treatment guidelines, the reduced access of patients to healthcare resources and the postponement of surgery. Prodromidou and colleagues studied how Enhanced Recovery after Surgery (ERAS) protocols may provide optimal management of patients with obesity and malignancy during the COVID-19 pandemic, with a special focus on patients who required surgery for gynecologic malignancy [ 68 ]. They highlighted the importance of the establishment of protective measures before surgery in order to reduce the exposure of cancer patients to SARS-CoV-2 while simultaneously improving vaccination access.…”