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Impact of Enhanced Recovery After Surgery on Postoperative Outcomes for Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

  • Peritoneal Surface Malignancy
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

A Correction to this article was published on 19 February 2021

This article has been updated

Abstract

Background

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been associated with significant morbidity and increased hospital length of stay (LOS). The authors report their experience after implementation of an enhanced recovery after surgery (ERAS) program for CRS-HIPEC.

Methods

Outcomes were analyzed before and after ERAS implementation. The components of ERAS included preoperative carbohydrate loading, goal-directed fluid management, multimodal pain management, minimization of narcotic use, avoidance of nasogastric tubes, and early mobilization and feeding.

Results

Of 168 procedures, 88 (52%) were in the pre-ERAS group and 80 (48%) were in the post-ERAS group. The two groups did not differ in terms of age, sex, comorbidities, peritoneal carcinomatosis index scores, completeness of cytoreduction, or operative time. The ERAS patients received fewer fluids intraoperatively (mean, 4.2 vs 6.4 L; p < 0.01). The mean LOS was 7.9 days post-ERAS compared with 10.0 days pre-ERAS (p = 0.015). Clavien–Dindo complications classified as grade ≥ 3 were lower after ERAS (23.7% vs 38.6%; p = 0.04). Moreover, the readmission rates remained the same (16.2% vs 13.6%; p = 0.635).

Conclusions

Implementation of an ERAS program for patients undergoing CRS-HIPEC is feasible and not associated with an increase in overall major complications or readmissions. These data support incorporation of ERAS protocols for CRS-HIPEC procedures.

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Authors and Affiliations

  1. Department of General Surgery, Division of Surgical Oncology, The University of Illinois at Chicago, 840 South Wood Street, M/C 820, Chicago, IL, 60612, USA

    Bradley White MD & George I. Salti MD

  2. Department of Surgical Oncology, Edward-Elmhurst Health, Naperville, IL, USA

    Fadi Dahdaleh MD, Jessica Berg PA, Wendy Wiemann MA & George I. Salti MD

  3. Department of Surgical Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA

    Samer A. Naffouje MD

  4. Department of Anesthesia, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA

    Neerav Kothari MD

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  1. Bradley White MD
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White, B., Dahdaleh, F., Naffouje, S.A. et al. Impact of Enhanced Recovery After Surgery on Postoperative Outcomes for Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 28, 5265–5272 (2021). https://doi.org/10.1245/s10434-020-09476-5

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  • DOI: https://doi.org/10.1245/s10434-020-09476-5

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