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Discontinuation of mechanical bowel preparation in advanced ovarian cancer surgery: an enhanced recovery after surgery (ERAS) initiative

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Abstract

Objective

To investigate the impact of discontinuation of mechanical bowel preparation in advanced ovarian cancer surgery within the context of the ERAS program.

Methods

We retrospectively reviewed the medical records of patients with advanced ovarian cancer who underwent cytoreductive surgery with simultaneous colon and/or rectal resection from January 2012 to November 2020. Patients were divided into two groups based on whether preoperative mechanical bowel preparation (MBP) was given (pre-ERAS) or not (post-ERAS). Patient characteristics, including duration of antibiotic treatment, surgical complexity, and incidence of surgical and nonsurgical complications, were compared.

Results

During the study period, 114 patients who underwent colon and/or rectal resection were examined, of whom 39 received MBP and 75 did not receive MBP (NMBP). On comparison between the two groups, no significant differences were noted in the assessed patient characteristics, including mean age, FIGO stage, ASA class, BMI, or residual tumor. One patient (2.6%) in the MBP group, and 4 patients (5.3%) in the NMBP group experienced an anastomotic leakage (p = 0.11). No significant differences were found with respect to surgical site infection. (p = 0.5).

Conclusion

MBP was not associated with any specific benefit for advanced ovarian cancer surgery. Gynecologic oncologists who use MBP should consider discontinuing this practice.

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References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70:7–30.

    Article  Google Scholar 

  2. Du Bois A, Reuss A, Pujade-Lauraine E, Harter P, Ray-Coquard I, Pfisterer J, et al. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectivelyrandomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe d’Investigateurs Nationaux Pour les Etudes des Cancers de l’Ovaire (GINECO). Cancer. 2009;115:1234–44.

    Article  Google Scholar 

  3. Chang S-J, Hodeib M, Chang J, Bristow RE. Survival impact of complete cytoreduction to no gross residual disease for advanced-stageovarian cancer: a meta-analysis. Gynecol Oncol. 2013;130:493–8.

    Article  Google Scholar 

  4. Tseng JH, Cowan RA, Zhou Q, Iasonos A, Byrnee M, Polcino T, et al. Continuous improvement in primary Debulking surgery for advanced ovarian cancer: do increased complete gross resection rates independently lead to increased progression-free and overall survival? Gynecol Oncol. 2018;151(1):24–31.

    Article  Google Scholar 

  5. Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, et al. Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS®) society recommendations: 2018. World J Surg. 2019;43(3):659–95.

    Article  CAS  Google Scholar 

  6. Nelson G, Bakkum-Gamez J, Kalogera E, Glaser Alon Altman G, Meyer AL, et al. Guidelines for perioperative care in gynecologic/oncology: enhanced recovery after surgery (ERAS) society recommendation 2019 update. Int J Gynecol Cancer. 2019;29(4):651–68.

    Article  Google Scholar 

  7. Bhandoria GP, Bhandarkar P, Ahuja V, Maheshwari A, Sekhon RK, Gultekin M, et al. Enhanced recovery after surgery (ERAS) in gynecologic oncology: an international survey of peri-operative practice. Int J Gynecol Cancer. 2020;30(10):1471–8.

    Article  Google Scholar 

  8. Sanchez-Iglesias JL, Carbonell-Socias M, Assumpcio Perez-Benavente MA, Clua SM, Manrique-Muñoz S, Gorriz MG, et al. PROFAST: a randomised trial implementing enhanced recovery after surgery for highcomplexity advanced ovarian cancer surgery. Eur J Cancer. 2020;136:149–58.

    Article  Google Scholar 

  9. Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

    Article  Google Scholar 

  10. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG, et al. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13:606–8.

    Article  CAS  Google Scholar 

  11. Tamussino KF, Lim PC, Webb MJ, Lee RA, Lesnick TG. Gastrointestinal surgery in patients with ovarian cancer. Gynecol Oncol. 2001;80(1):79–84. https://doi.org/10.1006/gyno.2000.6037.

    Article  CAS  Google Scholar 

  12. Stefanović A, Jeremić K, Kadija S, Milincić N, Mircić A, Petković S, et al. Intestinal surgery in treatment of advanced ovarian cancer–review of our experience. Eur J Gynaecol Oncol. 2011;32(4):419–22.

    Google Scholar 

  13. Paladini D, Fontanelli R, Raspagliesi F, Ntousias V. Intestinal operations during surgical procedures for epithelial ovarian cancer. Int J Gynecol Cancer. 1994;4:320–3.

    Article  Google Scholar 

  14. Smith ST, Seski JC, Copeland LJ, Gershenson DM, Edwards CL, Herson J. Surgical management of irradiation-induced small bowel damage. Obstet Gynecol. 1985;65:563–7.

    CAS  Google Scholar 

  15. Lippitt MH, Fairbairn MG, Matsuno R, Stone RL, Tanner EJ 3rd, Wick EC, et al. Outcomes associated with a five-point surgical site infection prevention bundle in women undergoing surgery for ovarian cancer. Obstet Gynecol. 2017;130(4):756–64.

    Article  Google Scholar 

  16. Lindemann K, Kok PS, Stockler M, Sykes P, Brand A. Enhanced recovery after surgery for suspected ovarian malignancy: a survey of perioperative practice among gynecologic oncologists in Australia and New Zealand to inform a clinical trial. Int J Gynecol Cancer. 2017;27(5):1046–50.

    Article  Google Scholar 

  17. Cao F, Li J, Li F. Mechanical bowel preparation for elective colorectal surgery: updated systematic review and meta-analysis. Int J Colorectal Dis. 2012;27:803–10.

    Article  CAS  Google Scholar 

  18. Dahabreh IJ, Steele DW, Shah N, et al. Oral mechanical bowel preparation for colorectal surgery: systematic review and metaanalysis. Dis Colon Rectum. 2015;58:698–707.

    Article  Google Scholar 

  19. Pineda CE, Shelton AA, Hernandez-Boussard T, et al. Mechanical bowel preparation in intestinal surgery: a meta-analysis and review of the literature. J Gastrointest Surg. 2008;12:2037–44.

    Article  Google Scholar 

  20. Slim K, Vicaut E, Launay-Savary M-V, et al. Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery. Ann Surg. 2009;249:203–9.

    Article  Google Scholar 

  21. Rollins KE, Javanmard-Emamghissi H, Lobo DN. Impact of mechanical bowel preparation in elective colorectal surgery: a meta-analysis. World J Gastroenterol. 2018;24(4):519–36.

    Article  Google Scholar 

  22. Koskenvuo L, Lehtonen T, Koskensalo S, Rasilainen S, Klintrup K, Ehrlich A, et al. Mechanical and oral antibiotic bowel preparation versus no bowel preparation for elective colectomy (MOBILE):a multicentre, randomised, parallel, single-blinded trial. Lancet. 2019;394:840–8.

    Article  CAS  Google Scholar 

  23. Espin Basany E, Solís-Peña A, Pellino G, Kreisler E, Fraccalvieri D, Muinelo-Lorenzo M, et al. Preoperative oral antibiotics and surgical-site infections incolon surgery ORALEV): a multicentre, single-blind, pragmatic, randomised controlled trial. Lancet Gastroenterol Hepatol. 2020;5(8):729–38.

    Article  Google Scholar 

  24. Golder AM, Steele CW, Conn D, MacKay JG, McMillan DC, Horgan PG, et al. Effect of preoperative oral antibiotics in combination with mechanical bowel preparation on inflammatory response andshort-term outcomes following left-sided colonic andrectal resections. BJS Open. 2019;3:830–9.

    Article  CAS  Google Scholar 

  25. Liu WT, Hsiao CW, Jao SW, Yu MH, Wu GJ, Liu JY, et al. Is preoperative bowel preparation necessary for gynecological oncology surgery? Taiwan J Obstet Gynecol. 2016;55:198–201.

    Article  Google Scholar 

  26. European Society of Coloproctology (ESCP) collaborating group. Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided colorectal resection: an international, multi-centre, prospective audit. Colorectal Dis. 2018;20(Suppl 6):15–32.

    Article  Google Scholar 

  27. Iniesta MD, Lasala J, Mena G, Rodriguez-Restrepo A, Salvo G, et al. Impact of compliance with an enhanced recovery after surgery pathway on patient outcomes in open gynecologic surgery. Int J Gynecol Cancer. 2019;29(9):1417–24.

    Article  Google Scholar 

  28. Sánchez-Iglesias JL, Gómez-Hidalgo NR, Pérez- Benavente A, Carbonell-Socias M, Manrique-Muñoz S, Pamies Serrano M, et al. Importance of enhanced recovery after surgery (ERAS) protocol compliance on length of stay in ovarian cancer surgery. Annals of Surg Oncol. 2021;28:8979–86.

    Article  Google Scholar 

  29. Ciccone MM, Aquilino A, Cortese F, Scicchitano P, Sassara M, et al. Feasibility and effectiveness of a disease and care management model in the primary health care system for patients with heart failure and diabetes (Project Leonardo). Vasc Health Risk Manag. 2010;6:297–305.

    Article  Google Scholar 

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Acknowledgements

We would like to thank Drs. Cristina Centeno Mediavilla, Silvia Cabrera Díaz and Melissa Bradbury (Gynecologic Oncology Department, Vall d´Hebron Hospital, Barcelona) for valuable collaboration and support within the working group.

Funding

No sources of funding were used.

Author information

Author notes

  1. José Luis Sánchez-Iglesias and Natalia R. Gómez-Hidalgo contributed equally.

Authors and Affiliations

  1. Gynecological Oncology Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

    José Luis Sánchez-Iglesias, Natalia R. Gómez-Hidalgo, Vicente Bebia, Asunción Pérez-Benavente & Antonio Gil-Moreno

  2. Division of Colorectal Surgery, Department of General Surgery, University Clinic Hospital Lozano Blesa, Zaragoza, Spain

    José Manuel Ramirez

  3. Division of Gynecologic Oncology, Tom Baker Cancer Centre, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Gregg Nelson

  4. Centro de Investigación Biomédica en Red de Cáncer, CIBERONC, Madrid, Spain

    Antonio Gil-Moreno

  5. Unit of Gynecologic Oncology, Service of Gynecology, Vall d’Hebron Barcelona Hospital Campus, Autonoma University of Barcelona, Passeig Vall d’Hebron 119–129, 08035, Barcelona, Spain

    Natalia R. Gómez-Hidalgo

Authors
  1. José Luis Sánchez-Iglesias
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Contributions

Conception and design of study: JLSI, NRGH, VBC, AGM. Data collection: JLSI. Data analysis and interpretation: JLSI, NRGH, VBC. Statistical analysis: VBC. Manuscript preparation: NRGH, JLSI, VBC, APB, GN, AGM, JMR. *Jose Luis Sánchez-Iglesias (JLSI), Asunción Pérez-Benavente (APB), Antonio Gil-Moreno (AGM), Natalia R. Gómez-Hidalgo (NRGH), Vicente Bebia Conesa (VBC), Jose Manuel Ramirez (JMR), Gregg Nelson (GN).

Corresponding author

Correspondence to Natalia R. Gómez-Hidalgo.

Ethics declarations

Conflict of interest

The Authors declare no financial conflicts of interest. Dr. Nelson reports speaker/advisory fees from Abbott, GSK, 3M and is the Secretary of the ERAS Society. Dr. Ramirez reports speaker/advisory fees from Vegenat, Vifor, Takeda, MSD, Menarini, BD and is the former president of the Spanish ERAS Society (GERM).

Compliance with ethics requirements

This study was carried out in the Unit of Gynecology Oncology at the Vall d’Hebron Hospital Campus in Barcelona, Spain.

Informed consent

The medical records of all patients who underwent cytoreductive surgery for advanced ovarian cancer with simultaneous colon or rectal resection from January 2012 to November 2020 were included.

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Sánchez-Iglesias, J.L., Gómez-Hidalgo, N.R., Bebia, V. et al. Discontinuation of mechanical bowel preparation in advanced ovarian cancer surgery: an enhanced recovery after surgery (ERAS) initiative. Clin Transl Oncol 25, 236–242 (2023). https://doi.org/10.1007/s12094-022-02934-4

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