Recommendations for the Perioperative Management of Pancreatic and Colorectal Cancer Patients

被引:0
作者
Vilz, Tim O. [1 ]
Post, Stefan [2 ]
Langer, Thomas [3 ]
Follmann, Markus [3 ]
Nothacker, Monika [4 ,5 ]
Willis, Maria A. [1 ]
机构
[1] Univ Hosp Bonn, Dept Surg, Bonn, Germany
[2] Univ Hosp Mannheim, Surg Clin, Mannheim, Germany
[3] German Canc Soc, German Guideline Program Oncol, Berlin, Germany
[4] Assoc Sci Med Soc Germany, Inst Med Knowledge Management, Berlin, Germany
[5] Philipps Univ Marburg, Marburg, Germany
来源
DEUTSCHES ARZTEBLATT INTERNATIONAL | 2024年 / 121卷 / 20期
基金
美国安德鲁·梅隆基金会;
关键词
ENHANCED RECOVERY; COLONIC SURGERY; PREVENTION; PROTOCOLS; OUTCOMES; THERAPY; LEAK;
D O I
10.3238/arztebl.m2024.0172
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Colorectal and pancreatic carcinoma are the most common cancers of the gastrointestinal tract. Their surgical treatment carries a high morbidity: complications arise in 25% to 30% of cases, often prolonging recovery times and delaying the initiation of adjuvant therapy, leading, in turn, to worse oncological outcomes. The goal of multimodal perioperative management (mPOM) is to lower the postoperative complication rate through a combination of perioperative measures. Methods: This guideline on the perioperative management of gastrointestinal tumors (POMGAT) meets all requirements for an S3 guideline as specified by the Association of the Scientific Medical Societies in Germany ( Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF). These include a systematic literature search, quality assessment of the included publications, an evaluation of the reliability of the evidence according to the GRADE approach, and a structured consensus process. Results: Meta-analyses have shown that mPOM lowers the complication rates of both pancreatic and colorectal resections (RD 0.96 with 95% confidence interval [0.92; 0.99] and RR 0.66 [0.54; 0.80], respectively). This shortens the hospital stay after pancreatic resections by a median of 2.33 days [-2.98; -1.69] and after colorectal resections by a median of 2.59 days [-3.22; -1.97]. Conclusion: Adherence to the POMGAT-S3 guideline for pancreatic and colorectal cancer surgery is associated with improved recovery, which can lead to a faster return to intended oncological treatment (RIOT) and thus to better long-term outcomes. These recommendations are not restricted to gastrointestinal cancer surgery; they can also be applied to visceral surgery for benign conditions, as well as to gynecological and urological operations.
引用
收藏
页码:681 / 687
页数:15
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