title: A call for new standard of care in perioperative gynecologic oncology practice: Impact of enhanced recovery after surgery (ERAS) programs.
abstract: Enhanced recovery after surgery (ERAS) programs aim to hasten functional recovery and improve postoperative outcomes. However, there is a paucity of data on ERAS programs in gynecologic surgery. We reviewed the published literature on ERAS programs in colorectal surgery, general gynecologic surgery, and gynecologic oncology surgery to evaluate the impact of such programs on outcomes, and to identify key elements in establishing a successful ERAS program. ERAS programs are associated with shorter length of hospital stay, a reduction in overall health care costs, and improvements in patient satisfaction. We suggest an ERAS program for gynecologic oncology practice involving preoperative, intraoperative, and postoperative strategies including; preadmission counseling, avoidance of preoperative bowel preparation, use of opioid-sparing multimodal perioperative analgesia (including loco-regional analgesia), intraoperative goal-directed fluid therapy (GDT), and use of minimally invasive surgical techniques with avoidance of routine use of nasogastric tube, drains and/or catheters. Postoperatively, it is important to encourage early feeding, early mobilization, timely removal of tubes and drains, if present, and function oriented multimodal analgesia regimens. Successful implementation of an ERAS program requires a multidisciplinary team effort and active participation of the patient in their goal-oriented functional recovery program. However, future outcome studies should evaluate the efficacy of an intervention within the pathway, include objective measures of symptom burden and control, study measures of functional recovery, and quantify outcomes of the program in relation to the rates of adherence to the key elements of care in gynecologic oncology such as oncologic outcomes and return to intended oncologic therapy (RIOT).
authors.affiliation: Department of Obstetrics and Gynecology, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Ester
authors.initials: E
authors.lastname: Miralpeix
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Alpa M
authors.initials: AM
authors.lastname: Nick
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Larissa A
authors.initials: LA
authors.lastname: Meyer
authors.affiliation: Department of Anesthesia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Juan
authors.initials: J
authors.lastname: Cata
authors.affiliation: Department of Anesthesia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Javier
authors.initials: J
authors.lastname: Lasala
authors.affiliation: Department of Anesthesia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Gabriel E
authors.initials: GE
authors.lastname: Mena
authors.affiliation: Department of Anesthesia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Vijaya
authors.initials: V
authors.lastname: Gottumukkala
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Iniesta-Donate
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Gloria
authors.initials: G
authors.lastname: Salvo
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address: peramire@mdanderson.org.
authors.forename: Pedro T
authors.initials: PT
authors.lastname: Ramirez
mesh_terms: D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000379:methods* / Q000592:standards*; D006801:Humans; D019990:Perioperative Care / Q000379:methods / Q000592:standards; D011183:Postoperative Complications / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D059039:Standard of Care
keywords: Enhanced recovery; Fast track; Gynecologic oncology; Gynecology; Rapid recovery; Surgery