- •Enhanced recovery after surgery (ERAS) decreases length of stay and readmission rates in advanced ovarian cancer surgery.
- •ERAS does not increase surgical morbidity in high complexity gynaecologic surgeries.
- •In ovarian cancer, ERAS is feasible, and a high rate of adherence can be achieved.
- •We recommend ERAS as standard practice for peritoneal carcinomatosis cytoreduction.
Enhanced recovery after surgery (ERAS) programs include multiple perioperative elements designed to achieve early recovery after surgery and a shorter length of stay (LOS) in hospital. The PROFAST trial aimed to expand the evidence base for implementing ERAS in advanced gynaecologic oncology surgery.
This prospective, interventional randomised clinical trial enrolled women undergoing surgery for either suspected or diagnosed advanced ovarian cancer, at a reference hospital in gynaecologic oncology in Barcelona (Spain) and who were treated after either an ERAS protocol or conventional management (CM) protocol. All enrolled women who underwent cytoreductive surgery were included in the primary analysis. The primary outcome was reduction in LOS, and secondary outcomes were incidence and type of intraoperative and postoperative complications, rate of readmission and mortality within a 30-d follow-up period. This trial is registered at ClinicalTrials.gov, number NCT02172638.
From June 2014 to March 2018, 110 women were recruited, of which eleven were excluded. The ERAS group comprised 50 patients, and the CM group, 49 patients. Both groups were comparable with respect to baseline characteristics and complexity of the cytoreductive surgery, with an overall medium/high Aletti surgical complexity score of 7.4. Overall compliance to the ERAS protocol was 92%. As compared with the patients in the CM group, patients in the ERAS group had a decreased median of LOS of two days (7 versus 9 days; p = 0.0099) and a decreased rate of readmission (6% versus 20%, p = 0.0334). No further significant differences were detected with respect to incidence of intraoperative or postoperative complications, severe (Clavien–Dindo grade IIIB–IV) complications, Comprehensive Complication Index, reoperation during primary stay, or mortality.
Patients with advanced ovarian cancer in the ERAS program had a decreased LOS and decreased rate of readmission as compared with those in CM, with no increased morbidity or mortality. This study provides important evidence for the benefits of ERAS management even for gynaecologic surgeries of medium/high complexity and suggests that ERAS should be a standard practice for cytoreductive surgeries for peritoneal carcinomatosis.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to European Journal of Cancer
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Multimodal approach to control postoperative pathophysiology and rehabilitation.Br J Anaesth. 1997; 78: 606-617
- Recovery after laparoscopic colonic surgery with epidural analgesia, and early oral nutrition and mobilisation.Lancet. 1995; 345: 763-764
- Implementation of enhanced recovery after surgery (ERAS) across a provincial healthcare system: the ERAS Alberta colorectal surgery experience.World J Surg. 2016; 40: 1092-1103
- Guidelines for perioperative care in gynecologic/oncology: enhanced Recovery after Surgery (ERAS) Society recommendations—2019 update.Int J Gynecol Canc. 2019; 29: 651-668
- American Cancer Society: cancer facts and figures 2016.American Cancer Society, Atlanta, GA2016
- Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.Int J Canc. 2018; 68: 394-424
- Epithelial ovarian cancer.Lancet. 2019; 393: 1240-1253
- Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe d'Investigateurs Nationaux Pour les Etudes des Cancers de l'Ovaire (GINECO).J Canc. 2009; 115: 1234-1244
- Prognostic impact of the time interval between surgery and chemotherapy in advanced ovarian cancer: analysis of prospective randomised phase III trials.Eur J Canc. 2013; 49: 142-149
- Complications of radical surgery for advanced ovarian cancer.Gynecol Obstet Fertil. 2011; 39: 21-27
- Enhanced recovery in gynecologic surgery.Obstet Gynecol. 2013; 122: 319-328
- The effect of accelerated rehabilitation on recovery after surgery for ovarian malignancy.Acta Obstet Gynecol Scand. 2006; 85: 488-492
- Surgical outcomes and morbidity after radical surgery for ovarian cancer in Aberdeen Royal Infirmary, the Northeast of Scotland Gynaecologic Oncology Centre.Anticancer Res. 2018; 38: 923-928
- Enhanced recovery after major gynaecological surgery for ovarian cancer-An objective and patient-based assessment of a traditional versus a multimodal “fast track” rehabilitation programme.Anästh Intensivmed. 2008; 49: 180-194
- A clinical pathway for patients undergoing primary cytoreductive surgery with rectosigmoid colectomy for advanced ovarian and primary peritoneal cancers.Gynecol Oncol. 2008; 108: 282-286
- A prospective study evaluating the impact of implementing the ERAS protocol on patients undergoing surgery for advanced ovarian cancer.Int J Gynecol Canc. 2019; 29: 605-612
- Aggressive surgical effort and improved survival in advanced-stage ovarian cancer.Obstet Gynecol. 2006; 107: 77-85
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004; 240: 205-213
- The Comprehensive Complication Index (CCI®): added value and clinical perspectives 3 years “down the line”.Ann Surg. 2017; 265: 1045-1050
- Enhanced recovery pathways in gynecologic oncology.Gynecol Oncol. 2014; 135: 586-594
- Enhanced recovery after surgery for suspected ovarian malignancy: a survey of perioperative practice among gynecologic oncologists in Australia and New Zealand to inform a clinical trial.Int J Gynecol Canc. 2017; 27: 1046-1050
- Risk factors for anastomotic leakage after colorectal resection in ovarian cancer surgery: a multi-centre study.Gynecol Oncol. 2019; 153: 549-554
- Enhanced recovery after minimally invasive gynecologic procedures with bowel surgery: a systematic review.J Minim Invasive Gynecol. 2019; 26: 288-298
- Enhanced recovery after surgery in gastric resections.Cir Esp. 2017; 95: 73-82
- Effect of goal-directed haemodynamic therapy on postoperative complications in low–moderate risk surgical patients: a multicentre randomised controlled trial (FEDORA trial).Br J Anaesth. 2018; 120: 734-744
- Is early oral feeding safe after elective colorectal surgery? A prospective randomized trial.Ann Surg. 1995; 222: 73-77
- Early oral versus “traditional” postoperative feeding in gynecologic oncology patients undergoing intestinal resection: a randomized controlled trial.Ann Surg Oncol. 2009; 16: 1660-1668
- Quality of life after early enteral feeding versus standard care for proven or suspected advanced epithelial ovarian cancer: results from a randomised trial.Gynecol Oncol. 2015; 137: 516-522
- Risks and benefits of thoracic epidural anaesthesia.Br J Anaesth. 2011; 107: 859-868
- A prospective randomized trial comparing patient-controlled epidural analgesia to patient-controlled intravenous analgesia on postoperative pain control and recovery after major open gynecologic cancer surgery.Gynecol Oncol. 2009; 114: 111-116
- A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer.Ann Surg. 2007; 245: 867
- A randomized controlled trial of postoperative nasogastric tube decompression in gynecologic oncology patients undergoing intra-abdominal surgery.Obstet Gynecol. 1996; 88: 399-402
- The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the use of bowel preparation in elective colon and rectal surgery.Dis Colon Rectum. 2019; 62: 3-8
- To drain or not to drain infraperitoneal anastomosis after rectal excision for cancer.Ann Surg. 2017; 265: 474-480
- A prospective randomised study of drains in infra-peritoneal rectal anastomoses.Tech Coloproctol. 2001; 5: 89-92
- Reducing postoperative venous thromboembolism complications with a standardized risk-stratified prophylaxis protocol and mobilization program.J Am Coll Surg. 2014; 218: 1095-1104
- Impact of early mobilization protocol on the medical-surgical inpatient population: an integrated review of literature.Clin Nurse Spec. 2012; 26: 87-94
- A systematic review to assess cost effectiveness of enhanced recovery after surgery programmes in colorectal surgery.Colorectal Dis. 2014; 16: 338-346
- Fast-track surgery in gynaecology and gynaecologic oncology: a review of a rolling clinical audit.ISRN Surgery. 2012; 2012
- Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery.Arch Surg. 2011; 146: 571-577
- Compliance with enhanced recovery after surgery program in gynecology: are all items of equal importance?.Int J Gynecol Canc. 2019; 29: 810-815
- International validation of Enhanced Recovery after Surgery Society guidelines on enhanced recovery for gynecologic surgery.Am J Obstet Gynecol. 2019; 221: 237-e1
Published online: July 18, 2020
Accepted: June 7, 2020
Received in revised form: May 27, 2020
Received: January 21, 2020
© 2020 Elsevier Ltd. All rights reserved.
ScienceDirectAccess this article on ScienceDirect
- Randomised controlled trial confirms benefit of enhanced recovery after surgery on length of stay in ovarian cancer: How low can we go?European Journal of CancerVol. 139
- PreviewWe applaud the authors of the PROFAST Trial , as this is the first published randomised controlled trial of Enhanced Recovery After Surgery (ERAS) versus conventional management (CM) focussed exclusively on advanced ovarian cancer surgery. The main finding of the study was a reduction in median length of stay (LOS) from 9 days in the CM group to 7 days in the ERAS group. There was a small reduction in readmissions favouring ERAS; however, no reduction in complications was reported.