Enhanced Recovery After Surgery Impact on the Systemic Inflammatory Response of Patients Following Gynecological Oncology Surgery: A Prospective Randomized Study

Jin Peng, Ruiying Dong, Jianfen Jiao, Min Liu, Xi Zhang, Hualei Bu, Ping Dong, Shasha Zhao, Naidong Xing, Shuai Feng, Xingsheng Yang, Beihua Kong, Jin Peng, Ruiying Dong, Jianfen Jiao, Min Liu, Xi Zhang, Hualei Bu, Ping Dong, Shasha Zhao, Naidong Xing, Shuai Feng, Xingsheng Yang, Beihua Kong

Abstract

Objective: Enhanced recovery after surgery (ERAS) protocol has widely gained acceptance in gynecological surgery. Its safety and efficacy should be evaluated fully via well-designed, randomized, control trials. The main objective of our study is to compare the ERAS protocol with the conventional perioperative care program after gynecological oncology. Furthermore, the secondary objectives of our study are the identification of markers that allow us to evaluate the effectiveness of the application of ERAS elements in the modulation of the body's response to surgical stress.

Methods: Patients with gynecological tumors indicated for surgery were randomly assigned to either the ERAS group or the conventional group. The ERAS protocol included short fasting time, fluid restriction, early oral feeding, reduced opioid consumption and immediate mobilization after surgery. The primary endpoint was the reduction of hospital stay in the ERAS group. The day of first flatus, postoperative nausea and vomiting (PONV), maximum pain score by the visual analogue scale (VAS) and complication, readmission rate, reoperation rate, postoperative mortality, total hospital cost and systemic inflammatory response (SIR) were secondary endpoints.

Results: A total of 130 patients in gynecological tumor surgery were enrolled (ERAS = 65, conventional = 65). The ERAS group had faster bowel function recovery, significantly less pain, less PONV, shorter hospital stay, and less total hospital costs. SIR markers were estimated and screened out that postoperative platelet, neutrophil-lymphocyte-ratio (NLR) and platelet-lymphocyte-ratio (PLR) were significantly lower in ERAS groups compared to conventional groups.

Conclusion: The implementation of ERAS protocol is safe and enhances postoperative recovery after gynecological oncology surgery. We firstly reveal the beneficial effect of ERAS protocols on the alleviation of postoperative SIR, which is a reflection of the magnitude of surgical trauma. Postoperative platelet, NLR or PLR could be the novel and inexpensive markers to assess how ERAS protocols modulate gynecological oncology surgery.

Trial registration: The trial was registered in ClinicalTrials.gov (NCT03629626).

Keywords: ERAS; NLR; PLR; enhanced recovery after surgery; gynecological oncology surgery; neutrophil-lymphocyte-ratio; platelet-lymphocyte-ratio; systemic inflammatory response.

Conflict of interest statement

The authors have no conflicts of interest to declare.

© 2021 Peng et al.

Figures

Figure 1
Figure 1
CONSORT diagram.
Figure 2
Figure 2
Postoperative results. (A) Maximum pain score assessed by the visual analogue scale (VAS); (B) postoperative nausea and vomiting (PONV) rate after surgery according to operative day and postoperative days.
Figure 3
Figure 3
Comparison of patients with ERAS protocols and patients with conventional protocols, in terms of preoperative or postoperative blood subtypes or the difference between preoperative and postoperative blood subtypes. Mean of WBC counts (A), neutrophil counts (B), lymphocyte counts (C), monocyte counts (D), platelet counts (E); difference of WBC counts (F), neutrophil counts (G), lymphocyte counts (H), monocyte counts (I) and platelet counts (J).
Figure 4
Figure 4
Comparison of patients with ERAS protocols and patients with conventional protocols, following gynecologic oncology surgery, in terms of preoperative NLR (A), MLR (B), and PLR (C); postoperative NLR (D), MLR (E), and PLR (F); difference between preoperative and postoperative NLR (G), MLR (H), and PLR (I).

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