GLIOMA-07 E.R.A.S. IN NEURO-ONCOLOGY

BACKGROUND: We performed a retrospective study assesses the efficacy and safety of a protocol for the enhanced recovery after surgery for supratentorial gliomas and metastasis.The protocol applied to the Ca' Foncello Hospital in Treviso starts from the recommendations on the subject that the medical literature reported up to December 2018.Briefly, three main sections:1) preoperative functional status evaluation, preoperative oral carbohydrate loading; 2) minimally invasive surgery, scalp incision anesthesia, nonopioid analgesia; 3) early urinary-catheter removal, standing and feeding resumption within 3-4 hours from surgery. METHODS: We analyzed data on 28 patients operated on ERAS protocol and compared them to a control group (22 patients). The main clinical variables are: age, ASA and Charlson comorbidity index; times urinary-catether removal, adherence ambulation, taking food by mouth; hospital long of stay (LOS). We also collected studies from 2016 to 2020 describing data about ERAS and craniotomy and we pooled these into a meta-analysis. RESULTS: Postoperative pain was significantly lower in the ERAS group (2.47 vs. 3.95, p-value=0.0007)) as long as time to removal of urinary catheter (3.1 vs. 25.0 hours, p-value < 0.001), adherence to ambulation (4 vs. 25 hours, p-value < 0.001), and first oral solid food intake (5.3 hours vs. 23.7 hours, p-value < 0.001). The mean LOS was 2.9 days in the ERAS group and 4.8 days in the control group (p-value < 0.001), and no differences in terms of surgical and medical complications, 30 days readmission rate, and time between surgery and RT were found. Our data are in line with those reported in the literature as highlighted by our meta-analysis, where hospital LOS and moderate to severe postoperative pain rates (> 4 points on NPRS) were significantly lower in ERAS patients. CONCLUSIONS: Our protocol for ERAS in neuro-oncology appears to have significant benefits over conventional management: it may accelerate functional recovery and decrease length of stay