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More information: Enhanced recovery after surgery (ERAS)

Enhanced recovery after surgery (ERAS) is a multimodal, multidisciplinary approach to the care of the surgical patient. Implementation involves a team of surgeons, anesthetists, an ERAS coordinator (often a nurse or a physician assistant), and staff from units that care for the surgical patient.

ERAS protocols are designed to achieve early recovery after surgical procedures by maintaining pre-operative organ function and reducing the profound stress response following surgery. Key elements of ERAS protocols:1Melnyk M, Casey RG, Black P, Koupparis AJ. Enhanced recovery after surgery (ERAS) protocols: time to change practice? Canadian Urological Association Journal. 2011;5(5):342-348. 

  • Preoperative counseling
  • Optimization of nutrition
  • Standardized analgesic and anesthetic regimens
  • Early mobilization

Resources on ERAS

Journal articles

Pędziwiatr M, Mavrikis J et al. Current status of enhanced recovery after surgery (ERAS) protocol in gastrointestinal surgery. Medical Oncology. 2018 May 9;35(6):95.

Taurchini M, Del Naja C, Tancredi A. Enhanced recovery after surgery: a patient centered process. Journal of Visualized Surgery. 2018 Feb 27;4:40.

Immunonutrition

Immunonutrition involves using specific nutrients to influence the activity of the immune system. Arginine, glutamine, branched chain amino acids, omega-3 fatty acids, and nucleotides have been studied most often.2Calder PC. Immunonutrition in surgical and critically ill patients. British Journal of Nutrition. 2007;98 Suppl 1:S133-S139. 

  • Fewer infections and shorter hospital stays with immunonutrition before surgery in malnourished patients compared to conventional nutrition support near the time of surgery in a meta-analysis3Calder PC. Immunonutrition. BMJ. 2003;327(7407):117-118. 
  • Fewer infectious and noninfectious complications after surgery, shorter hospital stays and better clinical outcomes among people with gastrointestinal cancer undergoing surgery with enteral immunonutrition before, during and/or after surgery compared to standard enteral nutrition in a meta-analysis of 27 RCTs4Song GM, Tian X et al. Immunonutrition support for patients undergoing surgery for gastrointestinal malignancy: preoperative, postoperative, or perioperative? a bayesian network meta-analysis of randomized controlled trials. Medicine (Baltimore). 2015 Jul;94(29):e1225.

More about safety

Preclinical evidence of greater tumor growth and metastasis among people treated with morphine

Expert approaches

Barbara MacDonald, ND, LAc

MacDonald B. The Breast Cancer Companion—A Complementary Care Manual: Third Edition. Self-published. 2016.

Naturopathic physician Barbara MacDonald provides information about breast cancer, its conventional treatment, and natural approaches to enhancing treatment, managing side effects, reducing risk of recurrence, and healthy living after cancer treatment is completed.

Gurdev Parmar, ND, FABNO, and Tina Kaczor, ND, FABNO

In their Textbook of Naturopathic Oncology: A Desktop Guide of Integrative Cancer Care. 1st edition, naturopathic oncologists Gurdev Parmar and Tina Kaczor discuss considerations for naturopathic care before and after surgery to optimize recovery, reduce pain, reduce risk post-surgical infections, and possibly reduce risk of metastasis.

Professional resources

Prehabilitation

Journal articles

McKenna NP, Bews KA et al. Assessing malnutrition before major oncologic surgery: one size does not fit all. Journal of the American College of Surgeons. 2020;230(4):451-460.

Minnella EM, Carli F. Prehabilitation and functional recovery for colorectal cancer patients. European Journal of Surgical Oncology. 2018;44(7):919-926.

Anesthesia and postoperative pain control

PubMed searches

Links to PubMed searches regarding use in cancer and surgery for each approach.

 

Pharmaceutical pain control

Opioid-based intravenous patient-controlled analgesia (meta-analysesa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study)

Transabdominal plane (TAP) blocks 

Multimodal pain management protocol 

Parecoxib 

Non-pharmaceutical pain control

Keep reading about integrative approaches to surgery

Authors

Laura Pole, RN, MSN, OCNS

Senior Clinical Consultant
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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, RN, MSN, OCNS Senior Clinical Consultant

Nancy Hepp, MS

Lead Researcher and Program Manager
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Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher, program manager, and writer for CancerChoices. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher and Program Manager

Reviewer

Whitney You, MD, MPH

Research Consultant
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Dr. You is a physician specializing in maternal-fetal medicine (MFM) with a specific interest in cancer in the context of pregnancy. She completed a postdoctoral fellowship in health services research with a focus in health literacy and received a Master of Public Health.

Whitney You, MD, MPH Research Consultant

Last update: June 20, 2022

CancerChoices provides information about integrativein cancer care, a patient-centered approach combining the best of conventional care, self care and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocial therapy, and acupuncture therapies and self-care lifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

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