Implementation of enhanced recovery protocols in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for metastatic ovarian cancer following neoadjuvant chemotherapy. A feasibility study

Objective: This study aims to assess the implementation of enhanced recovery after surgery (ERAS) protocols in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for metastatic ovarian cancer. ERAS protocols have been associated with improved perioperative outcomes in patients undergoing cytoreductive surgery for metastatic ovarian cancer, including reduced length of hospital stay, fewer postoperative complications, and enhanced patient recovery experiences.
Methods: This feasibility study involved a retrospective analysis of 66 patients: 31 who underwent cytoreductive surgery and HIPEC, and 35 in a control group who received cytoreductive surgery alone, prior to the introduction of the HIPEC program for metastatic ovarian cancer. All patients had received neoadjuvant chemotherapy before surgery. Compliance with the ERAS protocol elements was compared between the two groups.
Results: No significant differences in patient characteristics were observed between the two groups. Compliance with the eight ERAS protocol elements was 100% in both groups. However, the use of a nasogastric tube ASN007 was significantly more frequent in the HIPEC group (42% vs. 0%, p < 0.001). The proportion of patients mobilized on the first postoperative day was higher in the HIPEC group (87.1% vs. 57.1%, p = 0.007). There were no significant differences between the groups regarding early removal of urinary catheters (p = 0.12) or early initiation of feeding (p = 0.18). Additionally, no significant differences in complication rates, length of hospital stay, or readmission rates were found between the two groups.
Conclusion: The implementation of ERAS protocols is feasible and can be safely applied to patients undergoing cytoreductive surgery and HIPEC for metastatic ovarian cancer.