Highlights
- •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.
Abstract
Background
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.
Methods
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.
Findings
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.
Interpretation
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.
Keywords
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Article info
Publication history
Published online: July 18, 2020
Accepted:
June 7,
2020
Received in revised form:
May 27,
2020
Received:
January 21,
2020
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- 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 [1], 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.
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