Somashekhar S P, Rohit Kumar C, Fernandes Aaron, Ahuja Vijay, Aggarwal Kushal, Shanbhag Esha, Ashwin K R
Aster International Institute of Oncology Consultant - Surgical Oncologist Aster Hospital CMI, Bangalore, India.
Consultant Surgical Oncologist, Aster Whitefield Hospital, Bangalore, India.
Pleura Peritoneum. 2025 May 6;10(2):89-98. doi: 10.1515/pp-2024-0017. eCollection 2025 Jun.
To evaluate the implementation, compliance, and impact of the enhanced recovery after surgery (ERAS) protocol on perioperative outcomes in patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for Stage IIIc ovarian cancer.
From September 2020 to March 2022, the ERAS protocol (62 perioperative and special consideration guidelines) was prospectively implemented in 75 patients. Based on compliance rates, patients were divided into three groups: Group A (<70 %, 13 patients), Group B (70 %-80 %, 52 patients), and Group C (>80 %, 10 patients). Compliance rates, length of stay, postoperative complications, and readmission rates were analyzed. Ethical committee approval was obtained.
The cohort's average compliance was 74.5 %, with group averages of 68.4 %, 74.4 %, and 82.5 % (p<0.001). Tolerance to normal diet (p=0.008), postoperative ileus (p=0.161), and mobilization rates (p<0.001) improved with higher compliance. Higher compliance also led to shorter hospital stays (p=0.008) and ICU stays (p<0.001). Complications like ileus and infections were lowest in Group C. No significant differences were found in re-surgery or mortality.
Implementation of the ERAS protocol in patients undergoing CRS and HIPEC for Stage IIIc ovarian cancer is feasible and associated with improved postoperative outcomes. Higher compliance with ERAS guidelines significantly reduced length of hospital and ICU stay, enhanced early mobilization, and improved tolerance to diet, while also decreasing postoperative complications. Compliance above 80 % is necessary for achieving optimal outcomes and protocol modifications may improve compliance.
评估手术加速康复（ERAS）方案对接受减瘤手术（CRS）及热灌注化疗（HIPEC）治疗Ⅲc期卵巢癌患者围手术期结局的实施情况、依从性及影响。
2020年9月至2022年3月，对75例患者前瞻性实施ERAS方案（62条围手术期及特殊注意事项指南）。根据依从率，患者分为三组：A组（<70%，13例）、B组（70% - 80%，52例）和C组（>80%，10例）。分析依从率、住院时间、术后并发症及再入院率。获得伦理委员会批准。
该队列的平均依从率为74.5%，各组平均依从率分别为68.4%、74.4%和82.5%（p<0.001）。依从性越高，正常饮食耐受性（p=0.008）、术后肠梗阻（p=0.161）及活动率（p<0.001）改善越明显。更高的依从性还导致住院时间缩短（p=0.008）及重症监护病房（ICU）住院时间缩短（p<0.001）。C组肠梗阻和感染等并发症最少。再次手术或死亡率无显著差异。
对接受CRS及HIPEC治疗Ⅲc期卵巢癌的患者实施ERAS方案是可行的，且与改善术后结局相关。更高的ERAS指南依从性显著缩短了住院和ICU住院时间，增强了早期活动能力，改善了饮食耐受性，同时也减少了术后并发症。达到最佳结局需要依从率高于80%，修改方案可能会提高依从性。
