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After an operation for ovarian, womb or cervical cancer, enhanced recovery means eating a normal diet and getting up within a day, the drip and the urinary catheter out within a day, no routine drains, pain relief that relies less on opioids, and four weeks of blood clot injections after open surgery for cancer.
The ERAS Society has updated its gynecologic oncology guideline three times (2019, 2023 implementation update, 2026), but none of the updates is open and their abstracts state no recommendations. The latest edition whose recommendations could be read is the 2016 Part II on postoperative care (GRADE): compression stockings and intermittent pneumatic compression, and 28 days of extended prophylaxis after laparotomy for abdominal or pelvic cancer (high, strong); IV fluids stopped within 24 hours with balanced crystalloid (moderate, strong); a regular diet within 24 hours (high, strong); multimodal analgesia with regular paracetamol and an NSAID (high, strong); spinal anaesthesia with intrathecal morphine for open surgery (moderate, strong), with thoracic epidural an alternative (high, strong) and a TAP block where there is no neuraxial block (moderate, strong); no routine peritoneal drain, even after lymphadenectomy or bowel surgery (moderate, strong); urinary catheter out within 24 hours (low, strong); mobilisation within 24 hours (low, strong); laxatives and chewing gum to be considered (weak). NICE NG180 offers an enhanced recovery programme for all elective major surgery and allows clear fluids to 2 hours before.
Why: A coordinated package of care before, during and after the operation shortens recovery.
“Offer an enhanced recovery programme to people having elective major or complex surgery .”
NICE 2020 · Not graded (NICE NG180 1.2.1)
Why: The risk of a blood clot stays high for a month after open surgery for cancer, and extended injections more than halve it.
“Patients should wear well-fitting compression stockings and have intermittent pneumatic compression. Extended prophylaxis (28 days) should be given to patients after laparotomy for abdominal or pelvic malignancies.”
ERAS Society (Gynecologic Oncology) 2016 · Evidence level: High. Recommendation grade: Strong.
Why: Too much drip fluid causes swelling and slows the bowel; drinking replaces it.
“Intravenous fluids should be terminated within 24 h after surgery. Balanced crystalloid solutions are preferred to 0.9% normal saline.”
ERAS Society (Gynecologic Oncology) 2016 · Evidence level: Moderate. Recommendation grade: Strong.
Why: Eating early is safe after gynaecological cancer surgery, including bowel surgery, and helps recovery.
“A regular diet within the first 24 h after gynecologic/oncology surgery is recommended.”
ERAS Society (Gynecologic Oncology) 2016 · Evidence level: High. Recommendation grade: Strong.
Why: Combining non-opioid painkillers reduces the opioid needed, and with it sickness and a slow bowel.
“Acetaminophen and NSAIDs in combination should be administered regularly to all patients unless contraindication exists.”
ERAS Society (Gynecologic Oncology) 2016 · Evidence level: Use of multimodal analgesia: High. Combination of acetaminophen and NSAIDs: High. Recommendation grade: Strong.
Why: These reduce pain and opioid use after an abdominal incision; an epidural can slow getting up and catheter removal.
“Where patients have undergone general anesthesia without neuraxial blockade, a truncal block, such as TAP blocks, may reduce pain and opioid consumption for up to 24 h and should be employed.”
ERAS Society (Gynecologic Oncology) 2016 · Intrathecal morphine: Moderate. Thoracic epidural analgesia: High. TAP blocks: Moderate. Recommendation grade: Strong.
Why: Drains did not prevent complications in the trials and can delay recovery.
“Peritoneal drainage is not recommended routinely in gynecologic/oncology surgery including for patients undergoing lymphadenectomy or bowel surgery.”
ERAS Society (Gynecologic Oncology) 2016 · Evidence level: Moderate. Recommendation grade: Strong.
Why: A catheter left in raises the risk of urine infection and keeps people in bed.
“Urinary catheters should be used for postoperative bladder drainage for a short period preferably <24 h postoperatively.”
ERAS Society (Gynecologic Oncology) 2016 · Evidence level: Low. Recommendation grade: Strong.
Why: Moving early reduces clots, chest infection and muscle loss.
“Patients should be encouraged to mobilize within 24 h of surgery.”
ERAS Society (Gynecologic Oncology) 2016 · Evidence level: Low. Recommendation grade: Strong.
Why: Both may shorten the time until the bowel starts working again.
“The use of postoperative laxatives and chewing gum should be considered.”
ERAS Society (Gynecologic Oncology) 2016 · Evidence level: Laxatives: Low. Chewing gum: Moderate. Recommendation grade: Weak.
Why: High blood sugar after surgery raises the risk of infection and other complications.
“Perioperative maintenance of blood glucose levels (<180–200 mg/dL) results in improved perioperative outcomes. Glucose levels above this range should be treated with insulin infusions and regular blood glucose monitoring to avoid the risk of hypoglycemia.”
ERAS Society (Gynecologic Oncology) 2016 · Evidence level: Treating hyperglycemia above 180–200 mg/dL: High. Recommendation grade: Strong.
How care is usually carried out, read from the guidelines and standards cited. Your own team's protocol and their judgement come first; this page is for understanding it, not for doing it yourself.
The ERAS Society 2026 update is the current specialty standard, but no recommendation in it could be read. The latest readable recommendations, the 2016 postoperative guideline, are graded and most are strong: extended 28-day clot prevention after laparotomy for cancer, early diet and early stopping of IV fluids rest on high-quality evidence; no routine drains on moderate. NICE NG180 covers the general enhanced recovery programme and the 2-hour clear-fluid fast. Where ERAS 2016 is weakest is analgesia for major oncological and laparoscopic surgery (low evidence, weak).
ERAS Society (Gynecologic Oncology) 2026 · ERAS Society (Gynecologic Oncology) 2016 · NICE 2020
Where it differs: Uses a thoracic epidural as the main analgesia after laparotomy for cancer.
Evidence: ERAS 2016 says it reduces pain but may not improve other outcomes, often needs IV opioids as well, and can worsen low blood pressure; IV patient-controlled analgesia is a suitable alternative (low evidence, weak).
Where it differs: Gives 28 days of prophylaxis after laparoscopic surgery as well as open.
Evidence: ERAS 2016 says extended prophylaxis after minimally invasive surgery is likely not necessary without other high-risk features (raised BMI, previous VTE, coagulopathy, reduced mobility).
Enhanced recovery pathways feed people sooner, limit drips and drains and get them walking the day after an operation. Sixteen randomised trials in bowel surgery found 40 per cent fewer complications and stays more than two days shorter, but in 151 American hospitals given a full implementation programme, most failed to improve compliance with its elements.
Blood clots after a major operation for bowel, gynaecological or other abdominal cancer often appear after discharge. Extending preventive blood thinners to four weeks roughly halved clots in pooled trials without more major bleeding, and professional societies recommend it, yet among 23,527 older Americans having bowel cancer surgery in 2016 and 2017, 4.7 per cent received it.
| Recommendation | Grade, as printed | Source |
|---|---|---|
| Clear fluids until 2 hours before the operation “they may drink clear fluids until 2 hours before their operation” | Not graded (NICE NG180 1.4.1) | NICE 2020 |
| Spinal anaesthesia with intrathecal morphine for open surgery “Spinal anesthesia with intrathecal morphine is recommended” | Moderate Strong | ERAS Society (Gynecologic Oncology) 2016 |
| Thoracic epidural for major oncological surgery “TEA may be considered but patients frequently require additional IV opioids in addition to TEA to achieve adequate analgesia” | Evidence level: Low. Recommendation grade: Weak. | ERAS Society (Gynecologic Oncology) 2016 |
| Analgesia for laparoscopic surgery “Lack of evidence makes it difficult to recommend one analgesic intervention over another, however a multimodal approach should be employed” | Low Weak | ERAS Society (Gynecologic Oncology) 2016 |
Shares Routine tests before planned surgery, by size of operation and fitness, Surgical site infection prevention: skin preparation, antibiotic timing, warming and wound care, Four weeks of blood-clot prevention after major abdominal or pelvic cancer surgery, Enhanced recovery after colorectal cancer surgery (ERAS pathway for bowel resection).
Shares Routine tests before planned surgery, by size of operation and fitness, Surgical site infection prevention: skin preparation, antibiotic timing, warming and wound care, Prehabilitation (the pre-treatment window), Blood clot prevention around cancer surgery, including extended prophylaxis after major abdominal and pelvic operations.
Shares Routine tests before planned surgery, by size of operation and fitness, Surgical site infection prevention: skin preparation, antibiotic timing, warming and wound care, Enhanced recovery after colorectal cancer surgery (ERAS pathway for bowel resection), Prehabilitation (the pre-treatment window).
Shares Surgical site infection prevention: skin preparation, antibiotic timing, warming and wound care, Prehabilitation (the pre-treatment window), Blood clot prevention around cancer surgery, including extended prophylaxis after major abdominal and pelvic operations, Enhanced recovery after cancer surgery, with each element's compliance measured and fed back.
Shares Routine tests before planned surgery, by size of operation and fitness, Surgical site infection prevention: skin preparation, antibiotic timing, warming and wound care, Blood clot prevention around cancer surgery, including extended prophylaxis after major abdominal and pelvic operations, Enhanced recovery after cancer surgery, with each element's compliance measured and fed back.
Shares Routine tests before planned surgery, by size of operation and fitness, Surgical site infection prevention: skin preparation, antibiotic timing, warming and wound care, Blood clot prevention around cancer surgery, including extended prophylaxis after major abdominal and pelvic operations, Enhanced recovery after cancer surgery, with each element's compliance measured and fed back.
Shares Surgical site infection prevention: skin preparation, antibiotic timing, warming and wound care, Prehabilitation (the pre-treatment window), Blood clot prevention around cancer surgery, including extended prophylaxis after major abdominal and pelvic operations, Enhanced recovery after cancer surgery, with each element's compliance measured and fed back.
Shares Surgical site infection prevention: skin preparation, antibiotic timing, warming and wound care, Prehabilitation (the pre-treatment window), Blood clot prevention around cancer surgery, including extended prophylaxis after major abdominal and pelvic operations, Enhanced recovery after cancer surgery, with each element's compliance measured and fed back.