Enhanced Recovery After Surgery for Pelvic Cancer

Enhanced Recovery After Surgery (ERAS) is a multimodal concept combining pre-, peri- and postoperative care evidence based elements aiming to reduce surgical stress. ERAS has been shown to significantly reduce morbidity, length of hospital stay and total costs when applied to colonic surgery. It is therefore considered standard of care in this surgical specialty. Evidence from rectal surgery also suggests that this concept enhance patients recovery. There can be no doubt that ERAS principles have to be applied also in other major pelvic surgeries, such as cystectomy, radical prostatectomy and hysterectomy. However, uncritical application of the guidelines issued from colonic procedures seems inappropriate as the surgical procedures in pelvic cancer surgery differ (e.g. small bowel anastomosis and presence of urine within the peritoneal cavity for cystectomy, longer operative time, increased risk of blood loss). Thus, while there is little doubt that application of some type of ERAS protocols to pelvic cancer surgery will benefit the patients, there is clearly a need for careful adaptation of the many ERAS items for the different types of surgeries.