Enhanced recovery for gynecological oncology surgery—review

Enhanced recovery after surgery (ERAS) programs initially developed for colorectal surgery two decades ago have revolutionized the management of the surgical patient. By recognizing that the whole peri-operative period, not just the surgery itself, provides opportunities for evidence-based morbidity and length of stay (LoS) reducing interventions to be made, the quality and cost effectiveness of patient care has been improved. By considering and optimising the patients’ pre-operative physical (prehabilitation, carbohydrate loading, avoidance of bowel prep) and psychological (pre-admission education and counselling) condition, they arrive for surgery at a significant advantage. Intra-operatively, using an appropriate balanced anaesthetic technique, combined with minimally invasive surgery where possible, sensible fluid management, and multimodal analgesia continuing into the post-operative period, functional recovery has been shown to be enhanced. The promotion of early ambulation is facilitated by good multimodal analgesia, and reduced usage or earlier removal of abdominal drains and urinary catheters, which in turn reduces the venous thromboembolism (VTE) and post-operative infection risk. Robust discharge pathways including education of patients on discharge, may help to minimise unplanned readmissions. The ERAS principles applied to gynecological oncology surgery have been shown to be effective however the evidence is evolving and hence it is essential the adherence to and effectiveness of these pathways is continually audited.