Obstetrics and Gynecology Unit, Regina Montis Regalis Hospital, Mondovì (CN), Italy - MaNGO
Academic Department of Gynaecology and Obstetrics, University of Torino, Mauriziano Hospital, Torino, Italy - MaNGO.
Int J Gynecol Cancer. 2019 Jan;29(1):181-187. doi: 10.1136/ijgc-2018-000021.
This survey assessed the implementation of enhanced recovery after surgery (ERAS) for patients undergoing surgery for advanced ovarian cancer in three European cooperative study groups in Scandinavia, Italy, and Austria. The aim was to evaluate the landscape for future trials on ERAS pathways in ovarian cancer, because high-level evidence for such interventions is lacking.
In July 2017, a web-based questionnaire (SurveyMonkey Inc, Palo Alto, CA, USA) was sent to centers conducting surgery for advanced ovarian cancer within the Nordic Society of Gynecologic Oncology (NSGO), Mario Negri Gynecologic Oncology Group (MaNGO) and other Italian institutions, and the Association for Gynecologic Oncology Austria (AGO Austria) (n = 100). The survey covered all aspects of an ERAS pathway including surgery, nursing, and anesthesia. We herein report on the survey findings relating to surgery, including nursing care issues; however, anesthesiologic issues will be discussed in a separate report.
The overall response rate was 62%. Only a third of the centers in Italy and Austria follow a written ERAS protocol compared with 60% of the Scandinavian centers. Only a minority of centers have completely abandoned bowel preparation, with the highest proportion in Scandinavia (36%). Two hours of fasting for fluids before surgery is routinely practiced in Scandinavia and Austria (67-57%, respectively), but not in Italy (5%). Carbohydrate loading is routinely administered only in Scandinavia (67%). Peritoneal drainage is used by 22% routinely and by 61% in cases of bowel resection/lymphadenectomy/peritonectomy. Early feeding with a light diet on day 0 or 1 is the standard of care in Scandinavia and Austria, but not in Italy.
The degree of implementation of ERAS protocols varies across and within cooperative groups. The centralization of ovarian cancer care seems to facilitate standardization of peri-operative protocols. Currently, the high heterogeneity in patterns of care may challenge an international approach to a clinical trial.
本研究评估了在北欧妇科肿瘤学会（NSGO）、Mario Negri 妇科肿瘤学组（MaNGO）和其他意大利机构以及奥地利妇科肿瘤学会（AGO Austria）内开展高级卵巢癌手术的三个欧洲合作研究组中，增强术后恢复（ERAS）在接受手术的患者中的实施情况。其目的是评估未来卵巢癌 ERAS 路径临床试验的前景，因为缺乏此类干预措施的高级别证据。
2017 年 7 月，通过网络问卷调查（SurveyMonkey Inc，美国加利福尼亚州帕洛阿尔托），向 NSGO、MaNGO 及其他意大利机构和 AGO Austria（n=100）中开展高级卵巢癌手术的中心发送问卷。调查涵盖 ERAS 路径的各个方面，包括手术、护理和麻醉。我们在此报告与手术相关的调查结果，包括护理问题；然而，麻醉问题将在另一份报告中讨论。
总体回复率为 62%。与北欧中心的 60%相比，只有三分之一的意大利和奥地利中心遵循书面 ERAS 方案。只有少数中心完全放弃肠道准备，北欧中心的比例最高（36%）。在手术前 2 小时禁食液体的做法在北欧和奥地利常规实施（分别为 67%-57%），但在意大利则没有（5%）。仅在北欧常规给予碳水化合物负荷（67%）。在常规情况下，22%的中心使用腹腔引流，在肠切除/淋巴结清扫/腹膜切除术的情况下，61%的中心使用腹腔引流。在北欧，在第 0 天或第 1 天开始给予清淡饮食的早期喂养是标准的治疗方法，但在意大利则不是。
ERAS 方案的实施程度在合作组内和组间存在差异。卵巢癌治疗的集中化似乎有利于围手术期方案的标准化。目前，护理模式的高度异质性可能会对国际临床试验方法提出挑战。
