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Enhanced Recovery After Surgery (ERAS) for Para-aortic Lymphadenectomy-A New Trend to Consider?

Author(s): Isabelle Masquin, Houssein El Hajj, Christophe Zemmour, Camille Jauffret-Fara, Guillaume Blache, Mellie Heinemann, Laura Sabiani, Clément Brun, Gilles Houvenaeghel, Marion Faucher, Eric Lamb

Background: Enhanced recovery after surgery (ERAS) is a multimodal approach aiming to improve rehabilitation after surgery. In gynecologic malignancies, para-aortic lymphadenectomy (PAL) is indicated for either diagnostic or therapeutic finalities. Minimally invasive surgery (MIS) constitutes the cornerstone for ERAS programs.

Methods: This retrospective study conducted between November 2006 and January 2018, aims to analyze the role of ERAS implementation for patients undergoing PAL. Starting 2016, an ERAS protocol was implemented for all the patients in our institution. All patients who underwent PAL for gynecologic malignancies were included in this study. To analyze the impact of this implementation on the surgical outcomes (length of hospital stay (LOS)) and the post-operative complications, we compared the patients who underwent PAL within ERAS protocol between 2016 and 2018 “ERAS Group” to the patients who underwent PAL prior to this implementation (between 2006 and 2015) “Prior to ERAS group” Results: A total of 193 patients were identified. “ERAS Group” was associated with a significant decrease of median LOS (2 days vs. 3 days, p<0.001) and a significant increase in earlier post-operative discharges: OR=29.62 [13.58-64.64], p<0.001. Two factors were independently associated with early postoperative discharge: Implementation of the ERAS protocol (OR=25.64 [8.14-80.71], p<0.0001) and the endorsement of the extraperitoneal technique for PAL (OR=5.92 [2.10-16.68], p=0.0008). There was no difference in intra-operative complications rate between groups (p=0.497). More postoperative complications were found in the “ERAS group” (23% vs 10%, p=0.017) but this difference was not significant for severe complications (p=0.277) and lymphocele rate (p=0.248).

Conclusions: Implementing ERAS protocols for patients undergoing minimally invasive PAL is an independent factor improving early recovery and decreasing the LOS without increasing severe complications.

 

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