Enhanced Recovery After Surgery in Cytoreductive Surgery With HIPEC: Implementation and Outcomes From a High-Volume...

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with significant morbidity. Enhanced Recovery After Surgery (ERAS) protocols may improve perioperative outcomes, but data from low- and middle-income countries (LMICs) remain limited.

We conducted an ambispective study comparing patients undergoing CRS-HIPEC before (January 2015-June 2022; n = 294) and after (July 2022-June 2024; n = 70) ERAS implementation at a high-volume tertiary cancer centre. ERAS compliance and perioperative outcomes, including length of stay (LOS), major morbidity (Clavien-Dindo III-IV), mortality, readmission, and reoperation, were analysed.

Overall, ERAS compliance was 77.1%. Compliance was highest for preoperative and intraoperative components, while postoperative elements showed comparatively lower adherence. Median postoperative LOS decreased significantly from 8 to 5 days (p = 0.02). Major morbidity declined from 20.1% to 12.9%, although this was not statistically significant. Ninety-day mortality (4.6% vs 4.3%), readmission (15% vs 12.9%), and reoperation rates (13% vs 10%) were comparable between groups.

Implementation of an ERAS pathway for CRS-HIPEC in a high-volume LMIC centre is feasible and safe, resulting in shorter hospital stay without increasing morbidity or mortality.