Comment On: Enhanced Recovery After Surgery Pathway In Patients With Soft Tissue Sarcoma

Background Patients undergoing surgery for soft tissue sarcoma have high morbidity rates, particularly after preoperative radiation therapy (RT). An enhanced recovery after surgery (ERAS) programme may improve perioperative outcomes in abdominal surgery. This study reported outcomes of an ERAS programme tailored to patients with soft tissue sarcoma. Methods A prospective ERAS protocol was implemented in 2015 at a high-volume sarcoma centre. Patients treated within the ERAS programme from 2015 to 2018 were case-matched retrospectively with patients treated between 2012 and 2018 without use of the protocol, matched by surgical site, surgeon, sarcoma histology and preoperative RT treatment. Postoperative outcomes, specifically wound complications and duration of hospital stay, were reported. Results In total, 234 patients treated within the ERAS programme were matched with 237 who were not. The ERAS group had lower wound dehiscence rates overall (2 of 234 (0 center dot 9 per cent)versus31 of 237 (13 center dot 1 per cent);P < 0 center dot 001), after preoperative RT (0 of 41versus11 of 51;P = 0 center dot 004) and after extremity sarcoma surgery (0 of 54versus6 of 56;P = 0 center dot 040) compared with the non-ERAS group. Rates of postoperative ileus or obstruction were lower in the ERAS group (21 of 234 (9 center dot 9 per cent)versus40 of 237 (16 center dot 9 per cent);P = 0 center dot 016) and in those with retroperitoneal sarcoma (4 of 36versus15 of 36;P = 0 center dot 007). Duration of hospital stay was shorter in the ERAS group (median 5 (range 0-36)versus6 (0-67) days;P = 0 center dot 003). Conclusion Treatment within an ERAS protocol for patients with soft tissue sarcoma was associated with lower morbidity and shorter hospital stay.