Enhanced Recovery after Surgery Protocol in Major Oncological Gynecological Surgery

ABSTRACT

Introduction: In recent decades, ERAS (Enhanced Recovery After Surgery) protocols have been developed and implemented, aiming at the safe and rapid recovery of women with gynecological cancer after a surgical procedure, as well as reducing the length of stay (LOS) at the hospital.

Aim: To compare the effectiveness of the ERAS protocol and the conventional recovery method, in the postoperative course of patients undergoing major oncological gynecological operations due to cancer of the internal genital organs.

Methods: This is a prospective randomized single-center study of 100 women with cancer of the internal genital organs undergoing a major gynecological oncological operation, at a tertiary Oncology center in Athens. Patients are randomized into two equal groups: A following the ERAS protocol and B following conventional postoperative care. Parameters to be compared include LOS in hospital, time to initiation of feeding and mobilization as well as assessment of postoperative pain as reported by patients on Numerical Pain Scales (NPS).

Results: According to the results of the pilot study where the sample consisted of 61 patients (35 in group A and 26 in group B) with a mean age of 52.9 years (SD=11.7) it appeared that the hospital stay was significantly longer in the group B compared to group A (5.1±2.4 days vs. 3.1±1.3 days, p=0.001). Pain levels according to NPS were higher in group B at all time points except baseline. There are studies that highlight the contribution of ERAS programs to the reduction of LOS, the effective management of post-op pain, as well as the rapid feeding and mobilization of patients undergoing major gynecological oncological operation.

Conclusion: ERAS protocols promote timely feeding and mobilization, offer more effective post-op analgesia, improve the experiential post-op experience of patients, therefore increase their satisfaction, reduce LOS and hospitalization costs. Future studies, well conducted, may increase the certainty of these findings.

Keywords: ERAS protocols, rapid postoperative recovery, hysterectomy, major gynecological surgeries