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Related Experiment Video

Updated: Apr 9, 2026

Percutaneous Hepatic Perfusion PHP with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver
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Enhanced Recovery After Surgery in Cytoreductive Surgery With HIPEC: Implementation and Outcomes From a High-Volume

Babul Bansal1, Venugopal Ravi1, Rakesh Garg2

  • 1Department of Surgical Oncology, Dr. BRA-IRCH, AIIMS, Delhi, India.

Journal of Surgical Oncology
|April 8, 2026
PubMed
Summary

Enhanced Recovery After Surgery (ERAS) protocols for cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) are feasible in low- and middle-income countries (LMICs). Implementation significantly reduced hospital stay without increasing patient morbidity or mortality.

Keywords:
compliancecytoreductive surgery (CRS)enhanced recovery after surgery (ERAS)hyperthermic intraperitoneal chemotherapy (HIPEC)length of stay (LOS)lower‐middle income country (LMIC)

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Critical Care Medicine

Background:

  • Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a complex procedure with significant morbidity.
  • Enhanced Recovery After Surgery (ERAS) protocols aim to optimize perioperative outcomes.
  • Limited data exist on ERAS implementation for CRS-HIPEC in low- and middle-income countries (LMICs).

Purpose of the Study:

  • To evaluate the feasibility and impact of implementing an ERAS pathway for CRS-HIPEC in a high-volume LMIC cancer center.
  • To assess perioperative outcomes, including length of stay, morbidity, mortality, readmission, and reoperation rates, following ERAS implementation.

Main Methods:

  • An ambispective study compared patients undergoing CRS-HIPEC before and after ERAS implementation.
  • Data collected included ERAS compliance and key perioperative outcomes.
  • Statistical analysis compared outcomes between the pre- and post-ERAS groups.

Main Results:

  • Overall ERAS compliance was 77.1%, with higher adherence to preoperative and intraoperative components.
  • Median postoperative length of stay significantly decreased from 8 to 5 days (p=0.02).
  • Major morbidity, 90-day mortality, readmission, and reoperation rates showed no significant increase post-ERAS implementation.

Conclusions:

  • Implementing an ERAS pathway for CRS-HIPEC in an LMIC setting is feasible and safe.
  • ERAS implementation led to a significant reduction in hospital length of stay.
  • The study demonstrates that ERAS can be successfully integrated without compromising patient safety or increasing adverse outcomes.