Introduction Enhanced rehabilitation after surgery (ERAS) protocols have been developed these last 10 years in gynecological oncology. The objective is to assess their benefits on survival outcomes after a cytoreduction surgery for epithelial ovarian carcinoma (EOC).

Methods This retrospective cohort study was carried out in 2 centers between 2011 and 2023. All patients with primary, interval or closure laparotomy cytoreduction surgery for EOC, FIGO stage IC to IV, followed by adjuvant or maintenance therapy, were included. Patients were classified in two groups: adherence to ERAS protocol or conventional hospitalization (CH).

Results Seventy-two patients were classified in the ERAS group and 79 in the CH group. ERAS was significantly associated with shorter and simpler surgeries. The implementation of ERAS criteria has increased over time (p < 0.001). Patients of the ERAS group stayed on average 8.45 days against 10.44 days in the CH group (p < 0.001). There were less delayed postoperative complications in the ERAS group (7.0% versus 24.9%, p < 0.007). At 36 months, 32 recurrences occurred in ERAS group versus 36 in CH group (p = 0.44). At 60 months, 10 deaths occurred in ERAS group versus 22 in CH group (p = 0.77). Median return to intended oncologic therapy (RIOT) was shorter in ERAS group (36 days against 42, p = 0.26, and 35.5 days against 42 in the optimal surgery sub-group, excluding early stages, p = 0.084).

Conclusion/Implications ERAS protocol implementation in EOC surgical management could improve recurrence free survival and overall survival as it participates to reduce the RIOT.