Impact of enhanced recovery after surgery (ERAS) in the return to intended oncologic treatment in patients with advanced ovarian cancer.

Abstract

Purpose Treatment of advanced ovarian cancer (AOC) consists of cytoreductive surgery followed by chemotherapy (CT). Delays between surgery and CT could harm survival. Intensified recovery after surgery (ERAS) programs reduce hospital stay without increasing morbimortality. We hypothesized that ERAS protocols in patients undergoing surgery for AOC allow earlier initiation of CT and improve survival. Methods Retrospective cohort study including patients with ovarian, tubal, or primary peritoneal cancer, FIGO stages IIB-IV, undergoing debulking surgery and adjuvant CT at Vall d'Hebron Hospital (Spain). We compared patients within an ERAS protocol and those with conventional management (CONV). Time from surgery to CT, completion of treatment, overall survival and disease-free survival were compared, as well as the impact of adherence to ERAS on time to CT. Results We included 137 patients in the ERAS group and 46 in the CONV. CT started at a median of 44.5 days in the ERAS group and 48.5 in the CONV and was completed by 81.8% and 89.1%, respectively, without differences by type of surgery. No correlation between adherence to ERAS and CT onset time was observed, and no differences in survival. Conclusion There were no differences in time from surgery to CT, rate of CT completion and survival between patients who follow an ERAS protocol after surgery for AOC or a conventional management. A relationship between adherence to ERAS and an earlier onset of CT wasn't observed. This is the first study to evaluate the time to CT after different types of surgery for AOC within an ERAS protocol.