Enhanced Recovery After Surgery in Cytoreductive Surgery With HIPEC: Implementation and Outcomes From a High-Volume Tertiary Centre in a Lower-Middle Income Country.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.