Impact of enhanced recovery after surgery programs in the return to adjuvant chemotherapy in patients with advanced ovarian cancer.

OBJECTIVE

Advanced ovarian cancer treatment comprises cytoreductive surgery followed by chemotherapy. There is no established optimal time between surgery and chemotherapy initiation; however, delays can affect patient survival. Enhanced recovery after surgery (ERAS) programs aim to optimize post-operative recovery and may reduce delays in adjuvant treatment. This study investigated whether the implementation of the ERAS protocol reduces the time to chemotherapy after surgery for advanced ovarian cancer or influences the completion of planned chemotherapy cycles, evaluated the factors causing delays in chemotherapy, and examined the association between adherence to the ERAS protocol and the time to chemotherapy.

METHODS

This retrospective cohort study included patients with ovarian, tubal, or primary peritoneal cancer, International Federation of Gynecology and Obstetrics stages IIB to IV, who underwent debulking surgery and adjuvant chemotherapy at Vall d'Hebron Hospital. We compared the patients within the ERAS protocol with those under conventional management. The times from surgery to chemotherapy and completion of treatment were compared, in addition to the impact of ERAS adherence on the time to chemotherapy. Time to chemotherapy was measured both quantitatively and qualitatively (50 days cutoff).

RESULTS

A total of 137 and 46 patients were included in the ERAS and conventional groups, respectively. Chemotherapy started at a median of 44.5 days in the ERAS and 48.5 in the conventional group (p = .63) and was completed in 81.8% and 89.1% of patients, respectively, without differences by type of surgery. Compliance with the ERAS protocol did not correlate with earlier initiation of chemotherapy. Surgical morbidity, including complications, small bowel re-section, and intensive care unit admission, was identified as an independent risk factor for delayed chemotherapy.

CONCLUSIONS

Although ERAS programs improved post-operative recovery, they did not significantly reduce the time to chemotherapy or improve chemotherapy cycle completion in patients with advanced ovarian cancer, irrespective of adherence to the protocol.