Martin Hübner1, Shigeki Kusamura2, Laurent Villeneuve3, Ahmed Al-Niaimi4, Mohammad Alyami5, Konstantin Balonov6, John Bell7, Robert Bristow8, Delia Cortés Guiral9, Anna Fagotti10, Luiz Fernando R Falcão11, Olivier Glehen12, Laura Lambert13, Lloyd Mack14, Tino Muenster15, Pompiliu Piso16, Marc Pocard17, Beate Rau18, Olivia Sgarbura19, S P Somashekhar20, Anupama Wadhwa21, Alon Altman22, William Fawcett23, Jula Veerapong24, Gregg Nelson25. 1. Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Switzerland. Electronic address: martin.hubner@chuv.ch. 2. Peritoneal Surface Malignancy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 3. Clinical Research and Epidemiological Unit, Department of Public Health, Lyon University Hospital, EA 3738, University of Lyon, Lyon, France. 4. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, USA. 5. Department of General Surgery and Surgical Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia. 6. Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, USA. 7. Department of Anesthesiology, Basingstoke and North Hampshire Hospital, Basingstoke, UK. 8. Department of Obstetrics and Gynecologic Oncology, University of California, Irvine School of Medicine, Orange, USA. 9. Department of General Surgery (Peritoneal Surface Surgical Oncology). University Hospital Principe de Asturias, Alcalá de Henares, Madrid, Spain. 10. Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Catholic University of the Sacred Heart, 00168, Rome, Italy. 11. Discipline of Anesthesiology, Pain and Critical Care Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil. 12. Department of Digestive Surgery, Lyon University Hospital, EA 3738, University of Lyon, Lyon, France. 13. Peritoneal Surface Malignancy Program, Section of Surgical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA. 14. Department of Surgical Oncology, University of Calgary, Calgary, Alberta, Canada. 15. Department of Anaesthesiology and Intensive Care Medicine. Hospital Barmherzige Brüder, Regensburg, Germany. 16. Department of General and Visceral Surgery, Hospital Barmherzige Brüder, Regensburg, Germany. 17. Department of Digestive Surgery, Lariboisière University Hospital, Paris, France. 18. Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Germany. 19. Department of Surgical Oncology, Cancer Institute Montpellier (ICM), University of Montpellier, Montpellier, France. 20. Department of Surgical Oncology, Manipal Comprehensive Cancer Centre, Manipal Hospital, Bengaluru, India. 21. Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA. 22. Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Canada. 23. Anaesthesia and Pain Medicine, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK. 24. Department of Surgery, Division of Surgical Oncology, University of California San Diego, La Jolla, CA, USA. 25. Division of Gynecologic Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada.
Abstract
BACKGROUND: Enhanced recovery after surgery (ERAS) pathways have been shown to considerably reduce complications, length of stay and costs after most of surgical procedures by standardised application of best evidence-based perioperative care. The aim was to elaborate dedicated recommendations for cytoreductive surgery (CRS) ± hyperthermic intraperitoneal chemotherapy (HIPEC) in a two-part series of guidelines based on expert consensus. The present part I of the guidelines highlights preoperative and intraoperative management. METHODS: The core group assembled a multidisciplinary panel of 24 experts involved in peritoneal surface malignancy surgery representing the fields of general surgery (n = 12), gynaecological surgery (n = 6), and anaesthesia (n = 6). Experts systematically reviewed and summarized the available evidence on 72 identified perioperative care items, following the GRADE (grading of recommendations, assessment, development, evaluation) system. Final consensus (defined as ≥50%, or ≥70% of weak/strong recommendations combined) was reached by a standardised 2-round Delphi process, regarding the strength of recommendations. RESULTS: Response rates were 100% for both Delphi rounds. Quality of evidence was evaluated high, moderate low and very low, for 15 (21%), 26 (36%), 29 (40%) and 2 items, respectively. Consensus was reached for 71/72(98.6%) items. Strong recommendations were defined for 37 items, No consensus could be reached regarding the preemptive use of fresh frozen plasma. CONCLUSION: The present ERAS recommendations for CRS±HIPEC are based on a standardised expert consensus process providing clinicians with valuable guidance. There is an urgent need to produce high quality studies for CRS±HIPEC and to prospectively evaluate recommendations in clinical practice.
BACKGROUND: Enhanced recovery after surgery (ERAS) pathways have been shown to considerably reduce complications, length of stay and costs after most of surgical procedures by standardised application of best evidence-based perioperative care. The aim was to elaborate dedicated recommendations for cytoreductive surgery (CRS) ± hyperthermic intraperitoneal chemotherapy (HIPEC) in a two-part series of guidelines based on expert consensus. The present part I of the guidelines highlights preoperative and intraoperative management. METHODS: The core group assembled a multidisciplinary panel of 24 experts involved in peritoneal surface malignancy surgery representing the fields of general surgery (n = 12), gynaecological surgery (n = 6), and anaesthesia (n = 6). Experts systematically reviewed and summarized the available evidence on 72 identified perioperative care items, following the GRADE (grading of recommendations, assessment, development, evaluation) system. Final consensus (defined as ≥50%, or ≥70% of weak/strong recommendations combined) was reached by a standardised 2-round Delphi process, regarding the strength of recommendations. RESULTS: Response rates were 100% for both Delphi rounds. Quality of evidence was evaluated high, moderate low and very low, for 15 (21%), 26 (36%), 29 (40%) and 2 items, respectively. Consensus was reached for 71/72(98.6%) items. Strong recommendations were defined for 37 items, No consensus could be reached regarding the preemptive use of fresh frozen plasma. CONCLUSION: The present ERAS recommendations for CRS±HIPEC are based on a standardised expert consensus process providing clinicians with valuable guidance. There is an urgent need to produce high quality studies for CRS±HIPEC and to prospectively evaluate recommendations in clinical practice.
Authors: Barbara Costantini; Virginia Vargiu; Francesco Santullo; Andrea Rosati; Matteo Bruno; Valerio Gallotta; Claudio Lodoli; Rossana Moroni; Fabio Pacelli; Giovanni Scambia; Anna Fagotti Journal: Ann Surg Oncol Date: 2022-04-18 Impact factor: 4.339