Surgical Oncology

“I wasn’t allowed to eat for two days prior to surgery, I had to do a bowel preparation, and I was incredibly weak when I was wheeled into the operating room.

After surgery, I was in bed for quite some time,” Jenkins recalls. “When I finally could walk around, it was really painful. After going home, I distinctly remember my husband cooking — the smell of spices made me cough, and the coughing caused such incredible pain that I had to tell him to stop.”

A decade later, when Jenkins’ cancer returned and her MD Anderson doctors determined that surgery was again necessary, she jumped at the chance to participate in a protocol designed to relieve patients’ symptom burden and improve functional recovery.

To her absolute surprise, Jenkins’ experience with her second operation was dramatically different than her first.

“The night before, I enjoyed a family dinner, drank clear liquids until two hours prior to surgery, and didn’t have to endure a bowel preparation that had caused so much discomfort,” she says. “After surgery, I had almost no pain — I was up and walking and was soon eating a full meal. I even felt well enough to talk to my friends and put on my makeup in recovery.”

The principles of MD Anderson’s Enhanced Surgical Recovery Program (ESRP) involve making interventions before, during and after surgery that get patients through their surgery and recovery process much quicker and with better outcomes.

The movement is not new. Rather, it was pioneered almost two decades ago by a group of surgeons in Europe. It’s only more recently that physicians and institutions in the United States, including MD Anderson, have started to look more closely at its components.

Actually, many surgical practices are based more on traditions and previous teachings than sound scientific evidence, explains Pedro Ramirez, M.D., professor of Gynecologic Oncology and Reproductive Medicine.

“The pioneers of the movement questioned many traditional standards of practice that had been ingrained in the care of patients before, during and after surgery, and by doing so, came up with strategies that could benefit the patient,” says Ramirez, an ESRP co-lead. “With implementation, they found that patients were recovering much faster and getting back to their regular activities much sooner, resulting in an obvious improvement in quality of life.”

A gynecology ESRP has already registered 597 patients since its initiation in November 2014. Since then, there’s been a one-day drop in average length of hospital stay, an 80% reduction in opioid consumption and an improvement in patient-reported outcomes, without noting any differences in postoperative complication rates or readmissions. The program also has significantly lowered the cost of caring for patients.