Department of Gynaecologic Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India.
Department of Gynaecologic Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
Int J Gynecol Cancer. 2019 Mar;29(3):605-612. doi: 10.1136/ijgc-2018-000043. Epub 2019 Jan 4.
Information on the benefits of enhanced recovery after surgery (ERAS) when applied to advanced ovarian cancer() is minimal. The study objectives were to prospectively evaluate whether the implementation of ERAS in AOC patients improves post-operative recovery, and reduces the length of hospital stay (LOHS), without increasing the readmission rate or surgery-related complications; and to investigate ERAS protocol compliance.
This was a prospective interventional study carried out at a single university teaching hospital. Patients undergoing laparotomy for advanced ovarian cancer (stages IIb-IV) from March 2017 to February 2018 were managed using an ERAS protocol. The conventional management (CM) period extended from January 2016 to December 2016. The primary outcome was reduction in LOHS. Secondary outcomes were ERAS protocol compliance, incidence of post-operative complications, and readmission rate.
The CM and ERAS groups each comprised 45 patients. Both the groups were comparable in terms of clinicopathological and operative characteristic. Median LOHS of the full cohort, primary debulking cohort, interval debulking cohort, staging surgery cohort (all 6 vs 4 days; p<0.001), and complex cytoreductive surgery cohort (5 vs 4 days; p=0.019) were significantly reduced in the ERAS group. The overall compliance for the ERAS protocol was 90.6%. Occurrence of moderate or severe (17.8% vs 0%; p=0.003) and ≥grade 2 extended Clavein-Dindo complications (22.2% vs 0%; p=0.001); and hospital stay due to occurrence of complications (31.1% vs 2.2%; p<0.001) were also significantly reduced in the ERAS group. There was no difference in the 30-day readmission rates.
The results from our investigation suggest that the ERAS program can be successfully implemented in advanced ovarian cancer patients even in low-resource settings provided the program is modified to meet local needs so as not to increase healthcare costs.
关于在高级卵巢癌（AOC）中应用加速康复外科（ERAS）的益处的信息很少。本研究的目的是前瞻性评估在 AOC 患者中实施 ERAS 是否可以改善术后恢复，减少住院时间（LOHS），而不会增加再入院率或手术相关并发症；并调查 ERAS 方案的依从性。
这是一项在一家大学教学医院进行的前瞻性干预研究。2017 年 3 月至 2018 年 2 月，对接受剖腹手术治疗的高级卵巢癌（IIb-IV 期）患者采用 ERAS 方案进行管理。常规管理（CM）期从 2016 年 1 月延长至 2016 年 12 月。主要结局是减少 LOHS。次要结局是 ERAS 方案的依从性、术后并发症的发生率和再入院率。
CM 组和 ERAS 组各有 45 例患者。两组在临床病理和手术特征方面具有可比性。全队列、初次减瘤队列、间隔减瘤队列、分期手术队列（均为 6 天 vs 4 天；p<0.001）和复杂减瘤手术队列（5 天 vs 4 天；p=0.019）的 LOHS 中位数均显著降低。ERAS 方案的总体依从率为 90.6%。ERAS 组中严重或中度（17.8% vs 0%；p=0.003）和≥Clavein-Dindo 分级 2 级的扩展并发症（22.2% vs 0%；p=0.001）的发生率以及因并发症发生而导致的住院时间（31.1% vs 2.2%；p<0.001）也显著降低。30 天再入院率无差异。
我们的研究结果表明，即使在资源有限的情况下，也可以成功地将 ERAS 方案应用于高级卵巢癌患者，只要该方案经过修改以满足当地需求，而不会增加医疗保健成本。
