Prehabilitation programs and ERAS protocols in gynecological oncology: a comprehensive review
The “Enhanced recovery after surgery” (ERAS) concept has been continuously developed for many surgical disciplines. Shorter length of stay (LOS) and associated cost savings have been achieved without an increase in the complication or readmission rate. Current guidelines helped to support an increasing standardisation of care. One innovation of the recently published update is the proposal to integrate prehabilitation (PREHAB) into the ERAS concept. On this basis, the authors provide an overview of the current data on ERAS concepts in gynecological oncology and review the evidence of prehabilitation concepts.
Systematic literature review of all comparative studies on ERAS concepts in gynecological oncology and prehabilitation undergoing abdominal cancer surgery was performed using the standard databases. Outcomes of interest included prehabilitation program composition (exercise, nutritional, and psychological interventions), duration and outcome measures used to determine impact of prehabilitation vs. standard care.
Five studies reported on PREHAB programs in gynecology (three RCTs, one study protocol, one pilot study). There is no trial evaluating a pathway for patients with extensive ovarian or cervical cancer. Study protocols were heterogenous, but showed improvements in both physical and psychological parameters. ERAS protocols in ovarian cancer patients were investigated in 12 observational studies, mostly single center and only 1 RCT, in 4 studies patients with ovarian cancer or patients. Most studies showed improvement in complication rate and shorter LOS.
PREHAB programs seem feasible in abdominal cancer surgery and may improve surgical outcome. However, there is no prospective trial in gynecological oncology so far. Furthermore, there is no concept combining ERAS and PREHAB interventions. Therefore, the authors encourage the further development of both by describing in a novel treatment algorithm.
KeywordsGynecological oncology ERAS Prehabilitation Surgery Ovarian cancer
The authors state that each of the authors have provided substantial contribution and are in agreement with all aspects of the final manuscript.
Compliance with ethical standards
Conflict of interest
All the authors declare that he/she has no conflict of interest.
This article does not contain any studies with human participants performed by any of the authors.
- 4.Spanjersberg WR et al (2011) Fast track surgery vs. conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev 2:CD00635Google Scholar
- 18.Ataseven B et al (2018) Skeletal muscle attenuation (sarcopenia) predicts reduced overall survival in patients with advanced epithelial ovarian cancer undergoing primary debulking surgery. Ann Surg Oncol 25:3272–3379Google Scholar
- 29.Paterson C et al (2018) Development of a prehabilitation multimodal supportive care interventions for men and their partners before radical prostatectomy for localized prostate cancer. Cancer Nurs 42:E47–E53Google Scholar
- 30.Bruns ERJ et al (2018) Improving outcomes in oncological colorectal surgery by prehabilitation. Am J Phys Med Rehabil 98:231–238Google Scholar
- 32.Banerjee S et al (2013) O2 preoperative exercise protocol to aid recovery of radical cystectomy: results of a feasibility study. Eur Urol Supp 12(6):125Google Scholar
- 33.Dunne D et al (2014) 111 Prehabilitation before liver surgery. Eur J Surg Oncol EJSO 40(11):S52Google Scholar
- 55.Vermeiren S et al (2016) Frailty and the prediction of negative health outcomes: a meta-analysis. J Am Med Directors Assoc 17(12):1163.e1–1164.e17Google Scholar