# Enhanced recovery after cytoreductive surgery with or without HIPEC

Source: https://onco.cc/protocols/enhanced-recovery-after-cytoreductive-surgery-and-hipec/  
OnCo record `enhanced-recovery-after-cytoreductive-surgery-and-hipec` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Enhanced recovery is a package of care for major surgery to remove cancer from the lining of the abdomen, sometimes with heated chemotherapy: stopping smoking and drinking, a nutrition check, treating anaemia, a short fast, four weeks of clot prevention, careful temperature and fluids in theatre, good pain relief, no routine nose tube, drinking from the day of surgery and getting up early.

## Summary

The ERAS Society guideline for CRS with or without HIPEC (2020, two parts; 72 items graded by GRADE, consensus on 71 after a two-round Delphi of 24 experts, 37 strong recommendations, no consensus on preemptive fresh frozen plasma) is the only specialty guideline; only its abstracts could be read. Its item content is taken from the INDEPSO-ISPSM consensus (India, 2025), which reports it: preoperative counselling with smoking and heavy alcohol cessation; monitoring of intraperitoneal and core temperature, with active warming against hypothermia during CRS and against hyperthermia during HIPEC; at least two antiemetics; no prophylactic nasogastric drainage without risk factors for delayed gastric emptying; clear liquids on the day of surgery and solid food from day 1; preemptive enteral or parenteral nutrition for 7 days in selected patients; out of bed on the day of surgery with more than 2 hours of activity on day 2 and more than 6 hours after; urinary catheter out on the morning of day 3 when the bladder peritoneum was not stripped. The Indian consensus itself agreed on nutritional assessment, anaemia correction, fasting 6 to 8 hours for solids and 2 hours for liquids, carbohydrate loading, LMWH from 12 hours before surgery with pneumatic compression for 4 weeks, chlorhexidine-alcohol skin preparation, goal-directed fluids, and audit; it departed from ERAS by recommending drains for all patients and bowel preparation for left colonic or rectal resection. NICE NG180 (2020) offers enhanced recovery to everyone having elective major surgery.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: ERAS CRS HIPEC; ERAS cytoreductive surgery; enhanced recovery HIPEC; perioperative care for cytoreductive surgery; ERAS peritonectomy

## Connected records

- protocols: [Blood clot prevention around cancer surgery, including extended prophylaxis after major abdominal and pelvic operations](https://onco.cc/protocols/vte-prophylaxis-after-cancer-surgery/), [Enhanced recovery after liver surgery (ERAS pathway for hepatectomy)](https://onco.cc/protocols/enhanced-recovery-after-liver-surgery/), [Surgical site infection prevention: skin preparation, antibiotic timing, warming and wound care](https://onco.cc/protocols/surgical-site-infection-prevention/)
- cancers: [Appendiceal cancer and pseudomyxoma peritonei](https://onco.cc/cancers/appendiceal/), [Gastric & gastro-oesophageal junction cancer](https://onco.cc/cancers/gastric/), [Ovarian cancer](https://onco.cc/cancers/ovarian/), [Peritoneal mesothelioma](https://onco.cc/cancers/peritoneal-mesothelioma/)
- technologies: [Enhanced recovery (ERAS) and perioperative nutrition](https://onco.cc/technologies/eras-perioperative-nutrition/), [HIPEC / PIPAC (intraperitoneal chemotherapy)](https://onco.cc/technologies/hipec/), [HIPEC perfusion pumps and PIPAC nebulisers](https://onco.cc/technologies/hipec-pipac-devices/), [Prehabilitation before cancer surgery](https://onco.cc/technologies/prehabilitation/)
- terms: [Cytoreductive surgery](https://onco.cc/terms/cytoreductive-surgery/), [HIPEC (hyperthermic intraperitoneal chemotherapy)](https://onco.cc/terms/hipec-procedure/), [Peritoneal metastases from bowel cancer](https://onco.cc/terms/colorectal-peritoneal-metastases/), [Peritoneal metastasis](https://onco.cc/terms/peritoneal-metastasis/), [Prehabilitation (the pre-treatment window)](https://onco.cc/terms/prehabilitation-term/)
- ideas: [Clear drinks until two hours before an operation, rather than nothing from midnight](https://onco.cc/ideas/idea-pu-shorter-fasting-before-surgery/), [Enhanced recovery after cancer surgery, with each element's compliance measured and fed back](https://onco.cc/ideas/idea-pu-enhanced-recovery-with-measured-compliance/)

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