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Enhanced Recovery After Surgery for Advanced Ovarian Cancer: A Systematic Review of Interventions Trialed
  1. Kristina Lindemann, MD, PhD*,,,§,
  2. Peey-Sei Kok, MD*,,
  3. Martin Stockler, MD, PhD*,,
  4. Ken Jaaback, MD and
  5. Alison Brand, MD, PhD,,
  1. * NHMRC Clinical Trials Centre, University of Sydney; and
  2. Australian New Zealand Gynecological Oncology Goup (ANZGOG), Camperdown;
  3. Crown Princess Mary Cancer Centre, Westmead Hospital, Wentworthville;
  4. § Department of Gynecologic Oncology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway;
  5. Department of Gynaecological Oncology, John Hunter Hospital, Newcastle; and
  6. Department of Gynaecological Oncology, Westmead Hospital, Wentworthville, New South Wales, Australia.
  1. Address correspondence and reprint requests to Kristina Lindemann, MD, PhD, Department of Gynecological Cancer, The Norwegian Radium Hospital, Oslo University Hospital, PB 4953 Nydalen 0424 Oslo, Norway. E-mail: stinalindemann{at}


Objectives We sought to summarize the evidence for interventions aiming at enhanced recovery after surgery (ERAS) in ovarian cancer through a systematic review.

Methods We searched MEDLINE, EMBASE, and The Cochrane Library for studies testing ERAS interventions in patients undergoing surgery for ovarian cancer. Study selection and data extraction were done independently by 2 reviewers with disagreements resolved by discussion with a senior, third reviewer.

Results We identified 25 studies including 1648 participants with ovarian cancer. Nine observational studies addressed ERAS protocols. Four of them were prospective, and 3 included historical controls. The other 16 studies reported single interventions, for example, early feeding, omission of pelvic drains, early orogastric tube removal, Doppler-guided fluid management, and patient-controlled epidural analgesia. Early feeding protocols were tested in 7 of the 12 randomized trials. Early feeding appeared to be safe and was associated with significantly faster recovery of bowel function.

Conclusions Few studies have specifically studied ERAS interventions in ovarian cancer. All studies on protocols including multiple interventions were susceptible to bias. Early feeding is the intervention that is best supported by randomized trials. Application of evidence for ERAS derived from nonovarian cancer is challenged by the differences not only in the scope of surgery but also in ovarian cancer patients’ comorbidities. Postoperative morbidity is particularly high in these patients because of their poor nutritional status, perioperative fluids shifts, and long operating times. These patients may also show excessive response to surgical stress. Innovative, randomized trials are needed to reliably determine the feasibility, safety, and effectiveness of specific ERAS interventions in ovarian cancer.

  • Enhanced recovery
  • Fast-track
  • Ovarian cancer
  • Perioperative care
  • Systematic review

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  • The authors declare no conflicts of interest.