Optimizing patient recovery: prospective study evaluating compliance and clinical outcomes of enhanced recovery protocols in ovarian cancer following cytoreductive surgery with HIPEC.

Abstract

Objectives: 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.

Methods: 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.

Results: 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.

Conclusions: 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.