Implementation of the enhanced recovery after surgery protocol for patients with peritoneal carcinomatosis undergoing cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion

Introduction
To investigate the feasibility of enhanced recovery after surgery (ERAS) protocol for patients with primary peritoneal carcinomatosis (PC) undergoing cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (HIPEC) based on the length of hospital stay (LOS), return of bowel function, the incidence of postoperative complications, and quality of life (QLQ) analysis.

Material and methods
The study included a total of 37 patients with primary PC of different origin, who underwent cytoreductive surgery plus HIPEC. Patients were divided into 2 groups: Group I (nonERAS) – 20 patients and Group II (ERAS) – 17 patients.

Results
The median LOS in Group I (nonERAS) (12.35 ± 3.9) was longer than in Group II (ERAS) (6.8 ± 1.9) (p < 0.01). The use of the ERAS protocol significantly contributed to the faster return of bowel function (peristalsis and stool) in the postoperative period (p < 0.01). There was no statistically significant difference in the incidence of postoperative complications between the ERAS and nonERAS groups, which supports its clinical safety. Improved QLQ according to the obtained data has also been achieved due to the introduction of the principles of the ERAS protocol.

Conclusions
The obtained results prove the expediency and feasibility of the implementation of the ERAS protocol among patients undergoing cytoreductive surgery in combination with HIPEC.