Clinical evidence has demonstrated benefits in improving short-term clinical outcomes, quality of care and significantly reducing the cost of hospitalization after enhanced recovery after surgery (ERAS) in various types of surgeries. 

The increased number of cancer cases has further increased the proportion of cancer surgeries among all surgeries worldwide. Cancer surgery patients commonly require neoadjuvant chemotherapy afterwards, and the on-time initiation and completion of chemotherapy after surgery are critical for the prognosis, as recurrence and metastasis can directly influence the quality of life and long-term survival. An investigation utilized the literature search to identify studies on oncologic and long-term outcomes that examined: (1) ERAS versus conventional care, (2) high adherence to ERAS versus low adherence, and (3) the effects of altering one single item within the ERAS protocol.

This systematic review examines the long-term benefits of these, especially concerning cancer surgeries. 

The study utilized the data extracted from the studies and found-

26 relevant articles. 

12/18 articles, comparing ERAS and conventional care, reported long-term overall survival (OS), and only 4 among them found improvement by ERAS. 

4 studies showed disease-free survival (DFS), and only 1 favoured the improvement by ERAS. 

5 studies reported the outcomes of return to intended oncologic treatment after surgery (RIOT) and 4 reported improvements in the ERAS group. 

6/7 studies, comparing high adherence to ERAS with low adherence, reported the long-term OS, and 3 reported improvements by high adherence. 

1 study reporting high adherence could reduce the interval from surgery to RIOT. 

4 studies demonstrated the effect of altering one single item within the ERAS protocol, but the observations from 2 studies were controversial regarding the long-term OS between laparoscopic and open surgery, and 1 study showed improvements in OS with restrictive fluid therapy.

Thus it was concluded that using ERAS in cancer surgeries could improve the on-time initiation and completion of adjuvant chemotherapy after surgery, and the high adherence to ERAS can lead to better outcomes than low adherence.

But there remains difficultly to determine whether the ERAS protocol is associated with long-term overall survival or cancer-specific survival, from the current evidence.

Source: World J Surg Oncol. 2021;19(1):191. Published 2021 Jun 29. doi:10.1186/s12957-021-02306-2