Skip to main content
SpringerLink
Log in
Book cover

Pelvic Cancer Surgery pp 39–47Cite as

Enhanced Recovery After Surgery for Pelvic Cancer

  • Chapter
  • First Online:

  • 1981 Accesses

Abstract

Enhanced Recovery After Surgery (ERAS) is a multimodal concept combining pre-, peri- and postoperative care evidence based elements aiming to reduce surgical stress. ERAS has been shown to significantly reduce morbidity, length of hospital stay and total costs when applied to colonic surgery. It is therefore considered standard of care in this surgical specialty. Evidence from rectal surgery also suggests that this concept enhance patients recovery. There can be no doubt that ERAS principles have to be applied also in other major pelvic surgeries, such as cystectomy, radical prostatectomy and hysterectomy. However, uncritical application of the guidelines issued from colonic procedures seems inappropriate as the surgical procedures in pelvic cancer surgery differ (e.g. small bowel anastomosis and presence of urine within the peritoneal cavity for cystectomy, longer operative time, increased risk of blood loss). Thus, while there is little doubt that application of some type of ERAS protocols to pelvic cancer surgery will benefit the patients, there is clearly a need for careful adaptation of the many ERAS items for the different types of surgeries.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008;248(2):189–98.

    Article  PubMed  Google Scholar 

  2. Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr. 2011;29(4):434–40.

    Article  Google Scholar 

  3. Lassen K, Coolsen MM, Slim K, Carli F, de Aguilar-Nascimento JE, Schafer M, et al. Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS((R))) society recommendations. World J Surg. 2012;31:817.

    Google Scholar 

  4. Marx C, Rasmussen T, Jakobsen DH, Ottosen C, Lundvall L, Ottesen B, et al. The effect of accelerated rehabilitation on recovery after surgery for ovarian malignancy. Acta Obstet Gynecol Scand. 2006;85(4):488–92.

    Article  PubMed  Google Scholar 

  5. Arsalani-Zadeh R, ElFadl D, Yassin N, MacFie J. Evidence-based review of enhancing postoperative recovery after breast surgery. Br J Surg. 2011;98(2):181–96.

    Article  CAS  PubMed  Google Scholar 

  6. Muehling B, Schelzig H, Steffen P, Meierhenrich R, Sunder-Plassmann L, Orend KH. A prospective randomized trial comparing traditional and fast-track patient care in elective open infrarenal aneurysm repair. World J Surg. 2009;33(3):577–85.

    Article  PubMed  Google Scholar 

  7. Das-Neves-Pereira JC, Bagan P, Coimbra-Israel AP, Grimaillof-Junior A, Cesar-Lopez G, Milanez-de-Campos JR, et al. Fast-track rehabilitation for lung cancer lobectomy: a five-year experience. Eur J Cardiothorac Surg. 2009;36(2):383–91; discussion 391–2.

    Article  PubMed  Google Scholar 

  8. Reismann M, Dingemann J, Wolters M, Laupichler B, Suempelmann R, Ure BM. Fast-track concepts in routine pediatric surgery: a prospective study in 436 infants and children. Langenbeck’s Arch Surg/Deutsche Gesellschaft fur Chirurgie. 2009;394(3):529–33.

    Article  Google Scholar 

  9. Husted H, Jensen CM, Solgaard S, Kehlet H. Reduced length of stay following hip and knee arthroplasty in Denmark 2000–2009: from research to implementation. Arch Orthop Traumatol Surg. 2012;132(1):101–4.

    Article  Google Scholar 

  10. Arumainayagam N, McGrath J, Jefferson KP, Gillatt DA. Introduction of an enhanced recovery protocol for radical cystectomy. BJU Int. 2008;101(6):698–701.

    Article  PubMed  Google Scholar 

  11. Maffezzini M, Gerbi G, Campodonico F, Parodi D. A multimodal perioperative plan for radical cystectomy and urinary intestinal diversion: effects, limits and complications of early artificial nutrition. J Urol. 2006;176(3):945–8; discussion 948–9.

    Article  PubMed  Google Scholar 

  12. Pruthi RS, Nielsen M, Smith A, Nix J, Schultz H, Wallen EM. Fast track program in patients undergoing radical cystectomy: results in 362 consecutive patients. J Am Coll Surg. 2010;210(1):93–9.

    Article  PubMed  Google Scholar 

  13. Bessey PQ, Watters JM, Aoki TT, Wilmore DW. Combined hormonal infusion simulates the metabolic response to injury. Ann Surg. 1984;200(3):264–81.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  14. Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet. 2003;362(9399):1921–8.

    Article  PubMed  Google Scholar 

  15. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997;78(5):606–17.

    Article  CAS  PubMed  Google Scholar 

  16. Urbach DR, Baxter NN. Reducing variation in surgical care. BMJ (Clinical research ed). 2005;330(7505):1401–2.

    Article  Google Scholar 

  17. Bardram L, Funch-Jensen P, Jensen P, Crawford ME, Kehlet H. Recovery after laparoscopic colonic surgery with epidural analgesia, and early oral nutrition and mobilisation. Lancet. 1995;345(8952):763–4.

    Article  CAS  PubMed  Google Scholar 

  18. Andersen J, Hjort-Jakobsen D, Christiansen PS, Kehlet H. Readmission rates after a planned hospital stay of 2 versus 3 days in fast-track colonic surgery. Br J Surg. 2007;94(7):890–3.

    Article  CAS  PubMed  Google Scholar 

  19. Lassen K, Hannemann P, Ljungqvist O, Fearon K, Dejong CH, von Meyenfeldt MF, et al. Patterns in current perioperative practice: survey of colorectal surgeons in five northern European countries. BMJ (Clinical research ed). 2005;330(7505):1420–1.

    Article  Google Scholar 

  20. Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS((R))) society recommendations. World J Surg. 2012;31(6):783–800.

    CAS  Google Scholar 

  21. Nygren J, Thacker J, Carli F, Fearon KC, Norderval S, Lobo DN, et al. Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS((R))) society recommendations. World J Surg. 2012;31(6):801–16.

    CAS  Google Scholar 

  22. Adamina M, Kehlet H, Tomlinson GA, Senagore AJ, Delaney CP. Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery. 2011;149(6):830–40.

    Article  PubMed  Google Scholar 

  23. Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr (Edinb Scotl). 2010;29(4):434–40.

    Article  Google Scholar 

  24. Sammour T, Zargar-Shoshtari K, Bhat A, Kahokehr A, Hill AG. A programme of Enhanced Recovery After Surgery (ERAS) is a cost-effective intervention in elective colonic surgery. N Z Med J. 2010;123(1319):61–70.

    PubMed  Google Scholar 

  25. Lassen K, Soop M, Nygren J, Cox PB, Hendry PO, Spies C, et al. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg. 2009;144(10):961–9.

    Article  PubMed  Google Scholar 

  26. Levy BF, Scott MJ, Fawcett W, Fry C, Rockall TA. Randomized clinical trial of epidural, spinal or patient-controlled analgesia for patients undergoing laparoscopic colorectal surgery. Br J Surg. 2011;98(8):1068–78.

    Article  CAS  PubMed  Google Scholar 

  27. Brandstrup B, Svendsen PE, Rasmussen M, Belhage B, Rodt SA, Hansen B, et al. Which goal for fluid therapy during colorectal surgery is followed by the best outcome: near-maximal stroke volume or zero fluid balance? Br J Anaesth. 2011;109(2):191–9.

    Article  Google Scholar 

  28. Srinivasa S, Taylor MH, Singh PP, Yu TC, Soop M, Hill AG. Randomized clinical trial of goal-directed fluid therapy within an enhanced recovery protocol for elective colectomy. Br J Surg. 2013;100(1):66–74.

    Article  CAS  PubMed  Google Scholar 

  29. Borendal Wodlin N, Nilsson L, Kjolhede P. The impact of mode of anaesthesia on postoperative recovery from fast-track abdominal hysterectomy: a randomised clinical trial. BJOG. 2011;118(3):299–308.

    Article  CAS  PubMed  Google Scholar 

  30. Kroon UB, Radstrom M, Hjelthe C, Dahlin C, Kroon L. Fast-track hysterectomy: a randomised, controlled study. Eur J Obstet Gynecol Reprod Biol. 2010;151(2):203–7.

    Article  PubMed  Google Scholar 

  31. Moller C, Kehlet H, Friland SG, Schouenborg LO, Lund C, Ottesen B. Fast track hysterectomy. Eur J Obstet Gynecol Reprod Biol. 2001;98(1):18–22.

    Article  CAS  PubMed  Google Scholar 

  32. DeNardis SA, Holloway RW, Bigsby GE, Pikaart DP, Ahmad S, Finkler NJ. Robotically assisted laparoscopic hysterectomy versus total abdominal hysterectomy and lymphadenectomy for endometrial cancer. Gynecol Oncol. 2008;111(3):412–7.

    Article  PubMed  Google Scholar 

  33. Sharma R, Bailey J, Anderson R, Murdoch J. Laparoscopically assisted radical vaginal hysterectomy (Coelio-Schauta): a comparison with open Wertheim/Meigs hysterectomy. Int J Gynecol Cancer. 2006;16(5):1927–32.

    Article  CAS  PubMed  Google Scholar 

  34. Uccella S, Laterza R, Ciravolo G, Volpi E, Franchi M, Zefiro F, et al. A comparison of urinary complications following total laparoscopic radical hysterectomy and laparoscopic pelvic lymphadenectomy to open abdominal surgery. Gynecol Oncol. 2007;107(1 Suppl 1):S147–9.

    Article  PubMed  Google Scholar 

  35. Hautmann RE, Abol-Enein H, Davidsson T, Gudjonsson S, Hautmann SH, Holm HV, et al. ICUD-EAU International Consultation on Bladder Cancer 2012: urinary diversion. Eur Urol. 2012;63:67.

    Article  PubMed  Google Scholar 

  36. Hollenbeck BK, Miller DC, Taub D, Dunn RL, Khuri SF, Henderson WG, et al. Identifying risk factors for potentially avoidable complications following radical cystectomy. J Urol. 2005;174(4 Pt 1):1231–7; discussion 1237.

    Article  PubMed  Google Scholar 

  37. Shabsigh A, Korets R, Vora KC, Brooks CM, Cronin AM, Savage C, et al. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol. 2009;55(1):164–74.

    Article  PubMed  Google Scholar 

  38. Maffezzini M, Gerbi G, Campodonico F, Parodi D. Multimodal perioperative plan for radical cystectomy and intestinal urinary diversion. I. Effect on recovery of intestinal function and occurrence of complications. Urology. 2007;69(6):1107–11.

    Article  PubMed  Google Scholar 

  39. Brodner G, Van Aken H, Hertle L, Fobker M, Von Eckardstein A, Goeters C, et al. Multimodal perioperative management—combining thoracic epidural analgesia, forced mobilization, and oral nutrition—reduces hormonal and metabolic stress and improves convalescence after major urologic surgery. Anesth Analg. 2001;92(6):1594–600.

    Article  CAS  PubMed  Google Scholar 

  40. Gralla O, Haas F, Knoll N, Hadzidiakos D, Tullmann M, Romer A, et al. Fast-track surgery in laparoscopic radical prostatectomy: basic principles. World J Urol. 2007;25(2):185–91.

    Article  CAS  PubMed  Google Scholar 

  41. Novara G, Ficarra V, Rosen RC, Artibani W, Costello A, Eastham JA, et al. Systematic review and meta-analysis of perioperative outcomes and complications after robot-assisted radical prostatectomy. Eur Urol. 2012;62(3):431–52.

    Article  PubMed  Google Scholar 

  42. Sharma S, Kim HL, Mohler JL. Routine pelvic drainage not required after open or robotic radical prostatectomy. Urology. 2007;69(2):330–3.

    Article  PubMed  Google Scholar 

  43. Stevens RA, Mikat-Stevens M, Flanigan R, Waters WB, Furry P, Sheikh T, et al. Does the choice of anesthetic technique affect the recovery of bowel function after radical prostatectomy? Urology. 1998;52(2):213–8.

    Article  CAS  PubMed  Google Scholar 

  44. Biki B, Mascha E, Moriarty DC, Fitzpatrick JM, Sessler DI, Buggy DJ. Anesthetic technique for radical prostatectomy surgery affects cancer recurrence: a retrospective analysis. Anesthesiology. 2008;109(2):180–7.

    Article  PubMed  Google Scholar 

  45. Ahmed J, Khan S, Lim M, Chandrasekaran TV, Macfie J. Enhanced recovery after surgery protocols—compliance and variations in practice during routine colorectal surgery. Colorectal Dis. 2012;14(9):1045–51.

    Article  CAS  PubMed  Google Scholar 

  46. Kehlet H, Buchler MW, Beart Jr RW, Billingham RP, Williamson R. Care after colonic operation—is it evidence-based? Results from a multinational survey in Europe and the United States. J Am Coll Surg. 2006;202(1):45–54.

    Article  PubMed  Google Scholar 

  47. Gustafsson UO, Hausel J, Thorell A, Ljungqvist O, Soop M, Nygren J. Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg. 2011;146(5):571–7.

    Article  PubMed  Google Scholar 

  48. Maessen J, Dejong CH, Hausel J, Nygren J, Lassen K, Andersen J, et al. A protocol is not enough to implement an enhanced recovery programme for colorectal resection. Br J Surg. 2007;94(2):224–31.

    Article  CAS  PubMed  Google Scholar 

  49. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ (Clinical research ed). 2008;337:a1655.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, University Hospital Lausanne (CHUV), Lausanne, Switzerland

    Yannick Cerantola MD & Massimo Valerio MD

  2. Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland

    Martin Hubner PhD

  3. Department of GI/HPB Surgery, University Hospital Northern Norway, Tromsø, Norway

    Kristoffer Lassen MD, PhD

  4. Department of Anesthesia, McGill University Health Centre, Montreal, QC, Canada

    Francesco Carli MD, MPhil

  5. Department of Urology, Őrebro University Hospital, Őrebro, Sweden

    Beata M. E. Persson MD, FEBU

  6. Department of Urology, University Hospital Northern Norway, Tromsø, Norway

    Hitendra R. H. Patel MRCS, PhD, FRCS(Urol), FRCS(Eng)

Authors
  1. Yannick Cerantola MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Massimo Valerio MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martin Hubner PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kristoffer Lassen MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Francesco Carli MD, MPhil
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Beata M. E. Persson MD, FEBU
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hitendra R. H. Patel MRCS, PhD, FRCS(Urol), FRCS(Eng)
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yannick Cerantola MD .

Editor information

Editors and Affiliations

  1. Urology, University Hospital of North Norway, Tromsø, Norway

    Hitendra R.H. Patel

  2. University College London Hospital, London, United Kingdom

    Tim Mould

  3. Laparoscopic and Robotic Surgery, University of Rochester Medical Center, Rochester, New York, USA

    Jean V. Joseph

  4. Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA

    Conor P. Delaney

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag London

About this chapter

Cite this chapter

Cerantola, Y. et al. (2015). Enhanced Recovery After Surgery for Pelvic Cancer. In: Patel, H., Mould, T., Joseph, J., Delaney, C. (eds) Pelvic Cancer Surgery. Springer, London. https://doi.org/10.1007/978-1-4471-4258-4_5

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-4258-4_5

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-4257-7

  • Online ISBN: 978-1-4471-4258-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation