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

Cytoreductive surgery Enhanced recovery after surgery (ERAS) Hyperthermic intraperitoneal chemotherapy (HIPEC) Perioperative management Peritoneal metastases

Journal

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
ISSN: 1532-2157
Titre abrégé: Eur J Surg Oncol
Pays: England
ID NLM: 8504356

Informations de publication

Date de publication:
13 Jun 2024
Historique:
received: 07 03 2024
revised: 12 05 2024
accepted: 12 06 2024
medline: 7 7 2024
pubmed: 7 7 2024
entrez: 6 7 2024
Statut: aheadofprint

Résumé

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. 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. 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. 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.

Sections du résumé

BACKGROUND 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 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 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 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.

Identifiants

DOI: 10.1016/j.ejso.2024.108486 PMID: 38971013
pubmed: 38971013
pii: S0748-7983(24)00538-9
doi: 10.1016/j.ejso.2024.108486
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

108486

Informations de copyright

Copyright © 2024 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of competing interest The authors have no conflicts of interest or financial ties to disclose.

Auteurs

Manuela Robella (M)

Surgical Oncology Unit, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy. Electronic address: manuela.robella@ircc.it.

Marco Vaira (M)

Surgical Oncology Unit, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy.

Luca Ansaloni (L)

General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

Salvatore Asero (S)

Soft Tissue U.O. Surgical Oncology-Soft Tissue Tumors, Dipartimento di Oncologia, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Garibaldi Catania, 95123 Catania, Italy.

Stefano Bacchetti (S)

Advanced Surgical Oncology Center, ASUFC, DAME, University of Udine, 33100 Udine, Italy.

Felice Borghi (F)

Surgical Oncology Unit, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy.

Francesco Casella (F)

Upper GI Surgery Division, University of Verona, 37129 Verona, Italy.

Federico Coccolini (F)

General Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy.

Franco De Cian (F)

Ospedale Policlinico San Martino, Genova, Italy.

Andrea di Giorgio (A)

Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

Massimo Framarini (M)

General and Oncologic Department of Surgery, Morgagni - Pierantoni Hospital, AUSL Romagna, Forlì, Italy.

Roberta Gelmini (R)

General and Oncological Surgery Unit, AOU of Modena University of Modena and Reggio Emilia, Italy.

Luigina Graziosi (L)

University of Perugia, General and Emergency Surgery Department, Santa Maria Della Misericordia Hospital, Perugia, Italy.

Shigeki Kusamura (S)

Peritoneal Surface Malignancy Unit, Dept. of Surgery, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.

Piero Lippolis (P)

General and Peritoneal Surgery, Department of Surgery, Hospital University Pisa (AOUP), Pisa, Italy.

Rea Lo Dico (R)

Department of General and Emergency Surgery, S.Camillo-Forlanini Hospital, Rome, Italy.

Antonio Macrì (A)

Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Messina, Italy.

Daniele Marrelli (D)

Department of Medicine, Surgery, and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, 53100 Siena, Italy.

Paolo Sammartino (P)

CRS and HIPEC Unit, Pietro Valdoni, Umberto I Policlinico di Roma, 00161 Roma, Italy.

Cinzia Sassaroli (C)

UOSD Ricerca Integrata Medico Chirurgica nelle Neoplasie del Peritoneo, "Fondazione Giovanni Pascale" IRCCS, Naples, Italy.

Stefano Scaringi (S)

AOU Careggi, IBD Unit-Chirurgia Dell'Apparato Digerente, 50100 Firenze, Italy.

Marco Tonello (M)

Unit of Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.

Mario Valle (M)

Peritoneal Tumours Unit, IRCCS, Regina Elena Cancer Institute, 00144 Rome, Italy.

Antonio Sommariva (A)

Unit of Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.

Classifications MeSH