scholarly journals Enhanced recovery after surgery protocols improve time to return to intended oncology treatment following interval cytoreductive surgery for advanced gynecologic cancers

2021 ◽  
pp. ijgc-2021-002495
Author(s):  
Joan Isabelle Tankou ◽  
Olivia Foley ◽  
Michele Falzone ◽  
Rajeshwari Kalyanaraman ◽  
Kevin M Elias
Keyword(s):  
Adjuvant Chemotherapy ◽  
Cytoreductive Surgery ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Gynecologic Oncology ◽  
Multivariate Logistic Regression Analysis ◽  
Gynecologic Cancers ◽  
Oncology Treatment ◽  
American Society ◽  
Eras Protocol

ObjectiveThe objective of this study was to determine whether the implementation of an enhanced recovery after surgery (ERAS) protocol is associated with earlier return to intended oncology treatment following interval cytoreductive surgery for advanced gynecologic cancers.MethodsParticipants comprised consecutive patients (n=278) with a preoperative diagnosis of stage IIIC or IV ovarian cancer, divided into those that received treatment before versus after implementation of an ERAS protocol at our institution. All patients received at least three cycles of neoadjuvant chemotherapy with a platinum based regimen and underwent interval cytoreduction via laparotomy with the intent to deliver additional cycles of chemotherapy postoperatively. The primary outcome was defined as the timely return to intended oncologic treatment, defined as the percentage of patients initiating adjuvant chemotherapy within 28 days postoperatively.ResultsThe study cohorts included 150 pre-ERAS patients and 128 post-ERAS patients. Median age was 65 years (range 58–71). Most patients (211; 75.9%) had an American Society of Anesthesiologists score of 3, and the median operative time was 174 min (range 137–219). Median length of stay was 4 days (range 3–5 days) in the pre-ERAS cohort versus 3 days (range 3–4) in the post-ERAS cohort (p<0.0001). At 28 days after operation, 80% of patients had resumed chemotherapy in the post-ERAS cohort compared with 64% in the pre-ERAS cohort (odds ratio (OR) 2.29, 95% confidence interval (CI) 1.36 to 3.84; p=0.002). In multivariate logistic regression analysis, the ERAS protocol was the strongest predictor of timely return to intended oncology treatment (OR 10.18, 95% CI 5.35 to 20.32).ConclusionAn ERAS protocol for gynecologic oncology patients undergoing interval cytoreductive surgery is associated with earlier resumption of adjuvant chemotherapy.

The financial impact of an enhanced recovery after surgery (ERAS) protocol in an academic gynecologic oncology practice

2020 ◽  
Vol 156 (2) ◽  
pp. 284-287 ◽  
Author(s):  
Zachary L. Gentry ◽  
Teresa K.L. Boitano ◽  
Haller J. Smith ◽  
Dustin K. Eads ◽  
John F. Russell ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Gynecologic Oncology ◽  
Financial Impact ◽  
Oncology Practice ◽  
Eras Protocol

scholarly journals Role and impact of multimodal prehabilitation for gynecologic oncology patients in an Enhanced Recovery After Surgery (ERAS) program

2019 ◽  
Vol 29 (8) ◽  
pp. 1235-1243 ◽  
Author(s):  
Ester Miralpeix ◽  
Gemma Mancebo ◽  
Sonia Gayete ◽  
Marta Corcoy ◽  
Josep-Maria Solé-Sedeño
Keyword(s):  
Functional Capacity ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Gynecologic Oncology ◽  
Psychological Support ◽  
Gynecologic Surgery ◽  
Nutritional Counseling ◽  
Oncology Patients ◽  
Operative Recovery ◽  
Eras Protocol

Patients undergoing major surgery are predisposed to a decrease in functional capacity as a response to surgical stress that can delay post-operative recovery. A prehabilitation program consists of patient preparation strategies before surgery, and include pre-operative measures to improve functional capacity and enhance post-operative recovery. Multimodal prehabilitation may include exercise, nutritional counseling, psychological support, and optimization of underlying medical conditions, as well as cessation of unfavorable health behaviors such as smoking and drinking. Currently, there are no standardized guidelines for prehabilitation, and the existent studies are heterogeneous; however, multimodal approaches are likely to have a greater impact on functional outcomes than single management programs. We have reviewed the literature on prehabilitation in general, and in gynecologic surgery in particular, to identify tools to establish an optimal prehabilitation program within an Enhanced Recovery After Surgery (ERAS) protocol for gynecologic oncology patients. We suggest a safe, reproducible, functional, and easy-to-apply multimodal prehabilitation program for gynecologic oncology practice based on patient-tailored pre-operative medical optimization, physical training, nutritional counseling, and psychological support. The analysis of the prehabilitation program implementation in an ERAS protocol should undergo further research in order to test the efficacy on surgical outcome and recovery after surgery.

A cost analysis of the impact of enhanced recovery after surgery (ERAS) protocol in gynecologic oncology surgery

2019 ◽  
Vol 154 ◽  
pp. 211
Author(s):  
Z.L. Gentry ◽  
T.K.L. Boitano ◽  
H.J. Smith ◽  
J. Russell ◽  
D. Eads ◽  
...  
Keyword(s):  
Cost Analysis ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Gynecologic Oncology ◽  
Eras Protocol ◽  
The Impact

scholarly journals Enhanced Recovery After Surgery for Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Feng Mao ◽  
Zhenmin Huang
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Meta Analysis ◽  
Current Evidence ◽  
Eras Protocol ◽  
The Impact

Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a promising approach for the management of peritoneal carcinomatosis, but is associated with significant morbidity and prolonged hospital stay. Herein, we review the impact of Enhanced recovery after surgery (ERAS) protocol on length of stay (LOS) and early complications in patients undergoing CRS and HIPEC for peritoneal carcinomatosis.Methods: PubMed and Embase were searched for studies comparing ERAS protocol with control for CRS + HIPEC. Mean difference (MD) and risk ratios (RR) were calculated for LOS and complications respectively.Results: Six retrospective studies were included. Meta-analysis indicated statistically significant reduction in LOS with ERAS (MD: −2.82 95% CI: −3.79, −1.85 I2 = 29% p &lt; 0.00001). Our results demonstrated significantly reduced risk of Calvien Dindo grade III/IV complications with the use of ERAS protocol as compared to the control group (RR: 0.60 95% CI: 0.41, 0.87 I2 = 0% p = 0.007). Pooled analysis of limited studies demonstrated no statistically significant difference in the risk of reoperation (RR: 1.04 95% CI: 0.54, 2.03 I2 = 50% p = 0.90) readmission (RR: 0.55 95% CI: 0.21, 1.49 I2 = 0% p = 0.24), acute kidney injury (RR: 0.55 95% CI: 0.28, 1.10 I2 = 0% p = 0.09) or mortality (RR: 0.62 95% CI: 0.17, 2.26 I2 = 0% p = 0.46) between the study groups.Conclusion: For CRS + HIPEC, ERAS is associated with significantly reduced LOS along with lower incidence of complications. Limited data suggest that use of ERAS protocol is not associated with increased readmission, reoperation, and mortality rates in these patients. There is a need for randomized controlled trials to corroborate the current evidence.

scholarly journals Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

2019 ◽  
Vol 29 (4) ◽  
pp. 651-668 ◽  
Author(s):  
Gregg Nelson ◽  
Jamie Bakkum-Gamez ◽  
Eleftheria Kalogera ◽  
Gretchen Glaser ◽  
Alon Altman ◽  
...  
Keyword(s):  
Perioperative Care ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Care Pathway ◽  
Gynecologic Oncology ◽  
Evidence Base ◽  
Level Of Evidence ◽  
Assessment Development ◽  
Meta Analyses ◽  
Eras Protocol

BackgroundThis is the first updated Enhanced Recovery After Surgery (ERAS) Society guideline presenting a consensus for optimal perioperative care in gynecologic/oncology surgery.MethodsA database search of publications using Embase and PubMed was performed. Studies on each item within the ERAS gynecologic/oncology protocol were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.ResultsAll recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly.ConclusionsThe updated evidence base and recommendation for items within the ERAS gynecologic/oncology perioperative care pathway are presented by the ERAS® Society in this consensus review.

Impact of enhanced recovery after surgery (ERAS) protocol on gastrointestinal function in gynecologic oncology patients undergoing laparotomy

2018 ◽  
Vol 151 (2) ◽  
pp. 282-286 ◽  
Author(s):  
Teresa K.L. Boitano ◽  
Haller J. Smith ◽  
Tullia Rushton ◽  
Mary C. Johnston ◽  
Prentiss Lawson ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Gynecologic Oncology ◽  
Gastrointestinal Function ◽  
Oncology Patients ◽  
Eras Protocol

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

2021 ◽  
Author(s):  
Susanne Reuter ◽  
Linn Woelber ◽  
Constantin C. Trepte ◽  
Daniel Perez ◽  
Antonia Zapf ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Postoperative Complications ◽  
Length Of Stay ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Gynecologic Oncology ◽  
Long Term Outcome ◽  
Surgical Data ◽  
Eras Protocol ◽  
The Impact

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.

Sign in / Sign up

Export Citation Format

Share Document