Postoperatory Recovery in Advanced Ovarian Cancer, Fast-Track Protocol vs. Classical Management

Hospital Universitari Vall d'Hebron Research Institute110 enrolled

Overview

The concept of Fast-trak or Enhanced Recovery After Surgery ( ERAS) represents a new approach to the management of patients undergoing major surgery that re-examine traditional practices, replacing them if necessary with the best evidence based practices, creating a multimodal perioperative care pathway designed to achieve early recovery. In Colorectal Cancer Surgery , as well as in a number of other procedures it has been shown to reduce Hospitalization by more than 30% without increasing the rate complications or readmissions. However information on the results of Fast-track protocols when applied to Gynecological patients is sparse, being especially notorious the lack of data regarding the efficacy of Fast-track in the management of Advanced Gynecological cancer. Hypothesis: the application of a Fast-Track protocol in the management of patients with advanced Ovarian Cancer( Stage III, IV and relapses) may improve the postoperatory recovery of these patients allowing for an early discharge and significant cost reduction, when compared with de usual management, without increasing the number readmission or surgery related complications.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

NONE

Enrollment

110

Conditions

Median Length of Stay Readmission Rate

Eligibility

Sex: FEMALEMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * 18 years or more * Advanced ovarian cancer ( FIGO Stages III-IV, and relapses) tributary to laparotomic surgical management. * Patient accepts participation in the study and signs informed consent. Exclusion Criteria: * ASA IV * Active ischemic cardiac condition * Advanced cirrhosis ( Child-Pugh B -C). * Severe Psychiatric condition ( patient not capable of giving her informed consent properly, not capable or not willing to attend Follow-up visits).

Outcomes

Primary Outcomes

median length of stay

Time frame: participants will be followed for the duration of hospital stay, an expected average of 2 weeks.

Secondary Outcomes

Number of readmissions related to postoperative complications.

To determine if there is an statistically significant difference in the readmission rate related to postoperative complications between the Fast-track and Classical management groups.

Time frame: 28 days after surgery

Number of surgery related complications

To determine if there is an statistically significant difference in surgery related complications rates between the Fast-track and Classical management groups. The number and severity will be recorded. as graded in the Clavien-Dindo Classification of Surgical Complications.

Time frame: 28 days after surgery.

Cost per patient

To determine if the application of a Fast-Track protocol in advanced ovarian cancer patients generates a significant cost per patient reduction when compared with classical management. The total cost for Hospitalization , readmissions and surgery related complications will be assessed according to the Public prices published in : SLT/383/2009, 21th January "Diari Oficial de la Generalitat de Catalunya" Núm. 5325 - 24.2.2009.