Département de Chirurgie Colorectal, Hôpital Haut-Lévèque, 1 Avenue Magellan, 33604, Pessac, CHU Bordeaux, France.
Département de Chirurgie Colorectal, Hôpital Haut-Lévèque, 1 Avenue Magellan, 33604, Pessac, CHU Bordeaux, France.
Eur J Surg Oncol. 2021 Dec;47(12):3194-3201. doi: 10.1016/j.ejso.2021.07.013. Epub 2021 Jul 16.
Pelvic exenteration (PE) is a complex operative procedure, reserved for patients with locally advanced and recurrent pelvic malignancies. PE is associated with a high index of post-operative morbidity. Enhanced Recovery After Surgery (ERAS) programmes have been successful in improving postoperative outcomes, however, its application in PE has not been studied. The aim of our study is to assess the feasibility and short-term impact of ERAS on PE.
A dedicated PE ERAS programme was developed reflecting the complexity of differing subtypes of PE. A prospective cohort study was undertaken to evaluate the feasibility of implementing our PE ERAS between 2016 and 2020. The primary endpoint of this study was overall compliance with the ERAS programme.
145 patients were enrolled into our PE ERAS programme, with 86 (56.2%) patients undergoing a soft tissue PE, 27 (17.6%) a vascular PE and 32 (20.9%) a bony PE. The median overall compliance to the PE ERAS programme was 70% (IQR 55.5-88.8). There were no observed differences between overall compliance to the PE ERAS programme between different subtypes of PE (p = 0.60). Patients with higher compliance with the PE ERAS programme had a shorter LoS (p < 0.001), less post-operative morbidity (p < 0.001), reduced severity of Clavien-Dindo grade of morbidity (p < 0.001) and fewer readmissions (p = 0.03).
The principles of ERAS can be readily applied to patients undergoing PE, with high adherence to the ERAS programme associated with improved clinical outcomes.
盆腔廓清术（PE）是一种复杂的手术操作，仅适用于局部晚期和复发性盆腔恶性肿瘤患者。PE 术后并发症发生率高。强化术后康复（ERAS）方案已成功改善术后结果，但尚未研究其在 PE 中的应用。我们的研究旨在评估 ERAS 在 PE 中的可行性和短期影响。
制定了专门的 PE ERAS 方案，反映了不同类型 PE 的复杂性。进行了一项前瞻性队列研究，以评估 2016 年至 2020 年期间实施我们的 PE ERAS 的可行性。本研究的主要终点是 ERAS 方案的总体依从性。
145 例患者纳入我们的 PE ERAS 方案，其中 86 例（56.2%）患者行软组织 PE，27 例（17.6%）行血管 PE，32 例（20.9%）行骨 PE。PE ERAS 方案的总体依从率中位数为 70%（IQR 55.5-88.8）。不同类型 PE 之间对 PE ERAS 方案的总体依从率无差异（p=0.60）。PE ERAS 方案依从性较高的患者住院时间更短（p<0.001），术后并发症更少（p<0.001），Clavien-Dindo 分级严重程度更低（p<0.001），再入院率更低（p=0.03）。
ERAS 原则可轻易应用于行 PE 的患者，ERAS 方案的高依从性与改善的临床结果相关。
