Enhanced recovery after surgery (ERAS) for laparoscopic hysterectomy in low-risk endometrial cancer: a randomized controlled trial

Abstract

Background : Enhanced Recovery After Surgery (ERAS) programs aim for early recovery and reduced hospital length of stay (LOS). Their role in specific patient groups, such as those with early-stage endometrial cancer undergoing Minimally Invasive Surgery (MIS), is not well understood. Methods : This randomized controlled trial included low-risk patients with early-stage endometrial cancer who underwent total hysterectomy and salpingo-oophorectomy by laparoscopy. Patients were assigned to an ERAS protocol or a conventional control (CC) protocol. The primary outcome was LOS, while secondary outcomes included perioperative morbidity and quality of life (QoL). Results : From June 2019 to August 2021, 92 women were recruited, with 24 exclusions. Compliance with ERAS was 87.9%. ERAS patients showed significantly reduced hospitalization, with 67.6% discharged on the first postoperative day compared with 20.6% in the CC group ( p < 0.001). Median LOS was 1 day (interquartile range (IQR) 1–2) for ERAS vs. 2 days (IQR 2–2) for CC ( p < 0.001). No significant differences were found in postoperative complications or readmissions. However, QoL improved significantly in the ERAS group at 10 days ( p = 0.012) and 30 days ( p < 0.001) post-surgery, based on the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Pain scores on the Visual Analogue Scale (VAS) were also better in the ERAS group at 3 and 10 days ( p = 0.023 and p = 0.041). Conclusions : Patients with early-stage endometrial cancer benefit from ERAS protocols, achieving lower LOS and improved QoL after MIS. Clinical Trial Registration : NCT06732635, retrospectively registered.