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Oncology Advances January 2017

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6 | Oncology Advances Surgical teams at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC) are expanding their use of the Enhanced Recovery After Surgery (ERAS ® ) protocol based on the results seen among hundreds of patients. Currently in use for all non- emergent colorectal and radical cystectomy procedures, the ERAS protocol also is now being applied in gynecologic on- cology and surgical treatments for extremity sarcomas and is being evaluated for pancreatic and gastric procedures. Colorectal Pilot Study Improves Patient Outcomes Led by Ronald Bleday, MD, Chief of Colon and Rectal Surgery at Brigham and Women's Hospital, colorectal surgical teams at BWH and DF/BWCC perform approximately 600 colorectal procedures each year. A 2014 pilot study of the ERAS protocol in patients undergoing colorectal procedures showed a steep reduction in complication rates, as well as a shorter length of stay (Figure 1). The results were presented at the American Society of Colon and Rectal Surgeons (ASCRS) Annual Scientific Meeting in 2015. Reductions in rates of surgical site infection (SSI) and car- diac complications were among the most significant. SSI rates were reduced from nine percent to 3.2 percent. Rates of ar- rhythmia were reduced from 15.7 percent to 1.6 percent. Readmission rates also declined. The ERAS protocol was insti- tuted for all non-emergent DF/BWCC colorectal procedures beginning in March 2015. "The ERAS protocol offers profound benefits for patients with cancer who are undergoing major surgery," said Dr. Bleday. Enhanced Recovery After Surgery Protocol Demonstrates Reduction in Complications and Length of Stay "Patients have a faster return to intended oncologic therapy and are typically in better physical condition when they begin these therapies after surgery." Radical Cystectomy Protocol Results in Dramatic Reduction in Hospital Stay DF/BWCC was a leading center in the country to establish the ERAS protocol as standard practice for all cases of elective rad- ical cystectomy. The protocol was initially implemented in May 2015. Typical length of hospital stay for conventional radical cystectomy and urinary diversion is seven to eight days. Using the ERAS protocol, average length of stay has been reduced to four or five days (Figure 2). The team, led by urologist Mark A. Preston, MD, MPH, also expects to see a reduction in the risk for ileus, surgical site infections, fluid overload, and associ- ated cardiac complications. "The ERAS protocol helps the body to heal in the immediate perioperative period by using evidence-based practices to maintain normal body functioning while reducing the surgical stress response," said Dr. Preston. Figure 1: ERAS Colorectal Pilot Study: July 2014 to December 2014 Figure 2: ERAS Radical Cystectomy Study dfbwcc.org

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