Outcomes of Enhanced Recovery after Surgery (ERAS) in Gynecologic Oncology: A Review

Abstract

Enhanced Recovery After Surgery (ERAS) is a global surgical quality improvement program that started in colorectal surgery and has now expanded to numerous specialties, including gynecologic oncology. ERAS guidelines comprise multidisciplinary, evidence-based recommendations in the preoperative, intraoperative, and postoperative period; these interventions broadly encompass patient education, anesthetic choice, multimodal pain control, avoidance of unnecessary drains, maintenance of nutrition, and prevention of emesis. Implementation of ERAS has been shown to be associated with improved clinical outcomes (length of hospital stay, complications, readmissions) and cost. Marx and colleagues first demonstrated the feasibility of ERAS in gynecologic oncology in 2003; since then, over 30 comparative studies and 4 guidelines have been published encompassing major gynecologic surgery, cytoreductive surgery, and vulvar/vaginal surgery. Implementation of ERAS in gynecologic oncology has been demonstrated to provide improvements in length of stay, complications, cost, opioid use, and patient satisfaction. Increased compliance with ERAS guidelines has been associated with greater improvement in outcomes.

Enhanced Recovery Pathway Application for Perioperative Outcomes among Women Undergoing Gynecological Oncology Operations

“…In Egypt, 3.7-24% of women experience post-major gynecologic surgery perioperative problems (Abdelrazik et al, 2020). Since radical surgery is still the mainstay of treatment for gynecologic oncology, accepting and implementing an ERP for postoperative care can significantly improve patient recovery and have an impact on patient care and patient safety, which in turn leads to clinical advancements and financial savings for the healthcare (Bisch et al, 2022). Maternity nurses can be an essential part of developing and implementing ERP (Bajwah et al, 2020).…”

Medical disease and ambulatory surgery, new insights in patient selection based on medical disease

“…These multimodal efforts have resulted in a significant reduction in the need for hospitalization and with reduction in postoperative morbidity and mortality after many types of surgery [20 & ], for example, colorectal surgery [16], breast cancer surgery [21], major urological procedures, gynecological cancer surgery [22], obesity surgery [23], liver surgery [24], lung cancer surgery [25], as well as hip and knee arthroplasty [26].…”

Recuperación mejorada después de la cirugía. Aplicación de los protocolos ERAS en obstetricia y ginecología

“…El objetivo de las guías ERAS es minimizar la morbilidad quirúrgica a través de medidas basadas en la evidencia para normalizar la fisiología en el período perioperatorio. Los primeros estudios se centraron principalmente en la cirugía colorrectal, y no fue hasta 2003 que este concepto fue aplicado en oncología ginecológica (5). En esta área, en 2014, Wijk y cols.…”

“…Las directrices actualizadas también proporcionaron recomendaciones con respecto a los resultados informados por los pacientes, así como recomendaciones de auditoría e informes. Finalmente, las pautas para la cirugía vulvar y vaginal se publicaron en 2020 para abordar los requisitos únicos de recuperación en estas cirugías (5). Todas las recomendaciones sobre los ítems del protocolo ERAS se basan en la mejor evidencia disponible y presentan el nivel de evidencia para cada ítem.…”

“…Esta mejoría en los resultados parece ser adicional a la mayor aceptación en la cirugía mínimamente invasiva en oncología ginecológica. Se necesitan estudios futuros que utilicen las guías ERAS publicadas recientemente sobre la cirugía vulvar y vaginal (5).…”