Enhanced recovery after surgery (ERAS) implementation in cytoreductive surgery (CRS) and hyperthermic IntraPEritoneal chemotherapy (HIPEC) : Insights from Italian peritoneal surface malignancies expert centers

被引：1

作者：

Robella, Manuela ^{[1
]}

Vaira, Marco ^{[1
]}

Ansaloni, Luca ^{[2
]}

Asero, Salvatore ^{[3
]}

Bacchetti, Stefano ^{[4
]}

Borghi, Felice ^{[1
]}

Casella, Francesco ^{[5
]}

Coccolini, Federico ^{[6
]}

De Cian, Franco ^{[7
]}

di Giorgio, Andrea ^{[8
]}

Framarini, Massimo ^{[9
]}

Gelmini, Roberta ^{[10
]}

Graziosi, Luigina ^{[11
]}

Kusamura, Shigeki ^{[12
]}

Lippolis, Piero ^{[13
]}

Lo Dico, Rea ^{[14
]}

Macri, Antonio ^{[15
]}

Marrelli, Daniele ^{[16
]}

Sammartino, Paolo ^{[17
]}

Sassaroli, Cinzia ^{[18
]}

Scaringi, Stefano ^{[19
]}

Tonello, Marco ^{[20
]}

Valle, Mario ^{[21
]}

Sommariva, Antonio ^{[20
]}

机构：

[1] FPO IRCCS, Candiolo Canc Inst, Surg Oncol Unit, Candiolo, TO, Italy

[2] Fdn IRCCS Policlin San Matteo, Gen Surg, Pavia, Italy

[3] Azienda Ospedaliera Rilievo Nazl & Alta Specializz, Dipartimento Oncol, Soft Tissue UO Surg Oncol Soft Tissue Tumors, I-95123 Catania, Italy

[4] Univ Udine, Adv Surg Oncol Ctr, ASUFC, DAME, I-33100 Udine, Italy

[5] Univ Verona, Upper GI Surg Div, I-37129 Verona, Italy

[6] Pisa Univ Hosp, Gen Emergency & Trauma Surg, Pisa, Italy

[7] Osped Policlin San Martino, Genoa, Italy

[8] Fdn Policlin Univ A Gemelli IRCCS, Surg Unit Peritoneum & Retroperitoneum, Rome, Italy

[9] AUSL Romagna, Morgagni Pierantoni Hosp, Gen & Oncol Dept Surg, Forli, Italy

[10] AOU Modena Univ Modena & Reggio Emilia, Gen & Oncol Surg Unit, Modena, Italy

[11] Univ Perugia, Santa Maria Misericordia Hosp, Gen & Emergency Surg Dept, Perugia, Italy

[12] Fdn IRCCS Ist Nazl Tumori, Dept Surg, Peritoneal Surface Malignancy Unit, Milan, Italy

[13] Hosp Univ Pisa AOUP, Dept Surg Gen & Peritoneal Surg, Pisa, Italy

[14] SCamillo Forlanini Hosp, Dept Gen & Emergency Surg, Rome, Italy

[15] Univ Messina, Dept Human Pathol Adulthood & Childhood Gaetano Ba, Messina, Italy

[16] Univ Siena, Dept Med Surg & Neurosci, Unit Gen Surg & Surg Oncol, I-53100 Siena, Italy

[17] Umberto I Policlin Roma, CRS & HIPEC Unit, Pietro Valdoni, I-00161 Rome, Italy

[18] Fdn Giovanni Pascale IRCCS, UOSD Ric Integrata Med Chirurg nelle Neoplasie Per, Naples, Italy

[19] IBD Unit Chirurg Apparat Digerente, AOU Careggi, I-50100 Florence, Italy

[20] IRCCS, Veneto Inst Oncol IOV, Unit Surg Oncol Esophagus & Digest Tract, Padua, Italy

[21] IRCCS, Regina Elena Canc Inst, Peritoneal Tumours Unit, I-00144 Rome, Italy

来源：

EJSO | 2024年 / 50卷 / 09期

关键词：

Enhanced recovery after surgery (ERAS); Cytoreductive surgery; Hyperthermic intraperitoneal chemotherapy (HIPEC); Perioperative management; Peritoneal metastases; SOCIETY RECOMMENDATIONS; PERIOPERATIVE CARE; FLUID THERAPY; GUIDELINES; MANAGEMENT; DRAINAGE;

D O I：

10.1016/j.ejso.2024.108486

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background: Cytoreductive surgery (CRS) combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a complex procedure that involves extensive peritoneal and visceral resections followed by intraperitoneal chemotherapy. The Enhanced Recovery After Surgery (ERAS) program aims to achieve faster recovery by maintaining pre-operative organ function and reducing the stress response following surgery. A recent publication introduced dedicated ERAS guidelines for CRS and HIPEC with the aim of extending the benefits to patients with peritoneal surface malignancies. Methods: A survey was conducted among 21 Italian centers specializing in peritoneal surface malignancies (PSM) treatment to assess adherence to ERAS guidelines. The survey covered pre/intraoperative and postoperative ERAS items and explored attitudes towards ERAS implementation. Results: All centers completed the survey, demonstrating expertise in PSM treatment. However, less than 30 % of centers adopted ERAS protocols despite being aware of dedicated guidelines. Preoperative optimization was common, with variations in bowel preparation methods and fasting periods. Intraoperative normothermia control was consistent, but fluid management practices varied. Postoperative practices, including routine abdominal drain placement and NGT management, varied greatly among centers. The majority of respondents expressed an intention to implement ERAS, citing concerns about feasibility and organizational challenges. Conclusions: The study concludes that Italian centers specialized in PSM treatment have limited adoption of ERAS protocols for CRS +/- HIPEC, despite being aware of guidelines. The variability in practice highlights the need for standardized approaches and further evaluation of ERAS applicability in this complex surgical setting to optimize patient care.

引用

页数：8

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