Therapeutic impact of eras protocol implementation in cytoreductive surgery for ovarian cancer
Enhanced recovery after surgery (ERAS) protocols have been increasingly adopted over the past decade in gynecological oncology. This study aimed to evaluate the impact of ERAS adherence on survival outcomes following cytoreductive surgery for epithelial ovarian carcinoma (EOC). A retrospective cohort study was conducted across two centers between 2011 and 2023. Patients undergoing laparotomic cytoreduction for EOC, FIGO 2014 stages IC to IV, followed by adjuvant or maintenance therapy, were included. Participants were classified into two groups based on adherence to ERAS protocols or conventional hospitalization (CH). Seventy-two patients met criteria for the ERAS group and 79 for the CH group. ERAS adherence was associated with shorter operative times (mean 218.2 vs. 242.1 min, p < 0.049) and less complex surgeries. Length of hospital stay was significantly reduced in the ERAS group (mean 8.5 vs. 10.4 days, p < 0.001). Delayed postoperative complications were also lower (7.0 % vs. 24.9 %, p < 0.007). At 36 months, recurrence rates were comparable (32 in ERAS vs. 36 in CH, p = 0.44), as were 60-month mortality rates (10 vs. 22 deaths, p = 0.77). Median return to intended oncologic therapy (RIOT) tended to be shorter in the ERAS group (36 vs. 42 days, p = 0.26), reaching near significance in the subgroup with optimal surgery excluding early stages (35.5 vs. 42 days, p = 0.084). ERAS protocol implementation in EOC surgery enhances postoperative recovery and shows a promising trend toward reducing RIOT, highlighting its potential role in optimizing oncologic management.