van Stein Ruby M, Lok Christianne A R, Aalbers Arend G J, H J T de Hingh Ignace, Houwink Aletta P I, Stoevelaar Herman J, Sonke Gabe S, van Driel Willemien J
Department of Gynaecological Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
Center for Gynaecologic Oncology Amsterdam, Amsterdam, the Netherlands.
Gynecol Oncol Rep. 2022 Feb 26;39:100945. doi: 10.1016/j.gore.2022.100945. eCollection 2022 Feb.
Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is standard of care in the Netherlands in patients with stage III epithelial ovarian cancer following interval cytoreductive surgery (CRS). Differences in patient selection, technical aspects, and perioperative management exist between centers performing HIPEC. Standardization aims to reduce unwanted variation in clinical practice. As part of an implementation process, we aimed to standardize perioperative care for patients treated with CRS and HIPEC using a Delphi-based consensus approach.
We performed a two-phase modified Delphi method involving a multidisciplinary panel of 40 experts who completed a survey on CRS and HIPEC. During a consensus meeting, survey outcomes and available scientific evidence was discussed. Items without consensus (<75% agreement) were adjusted and evaluated in a second survey.
Consensus was reached in the first round on 51% of items. After two rounds, consensus was reached on the majority of items (82%) including patient selection, preoperative workup, technical aspects of CRS and HIPEC, and postoperative care. No consensus was reached on the role of HIPEC in rare ovarian cancer types, preoperative bowel preparation, timing to create bowel anastomoses, and manipulation of the perfusate.
Dutch experts reached consensus on most items regarding interval CRS and HIPEC for ovarian cancer. This consensus study may help to align treatment protocols and to minimize practice variation. Topics without consensus may be put on the research agenda of HIPEC for ovarian cancer.
在荷兰，对于接受间歇性肿瘤细胞减灭术（CRS）后的Ⅲ期上皮性卵巢癌患者，热灌注腹腔化疗（HIPEC）是标准治疗方法。实施HIPEC的各中心在患者选择、技术方面和围手术期管理上存在差异。标准化旨在减少临床实践中不必要的差异。作为实施过程的一部分，我们旨在采用基于德尔菲法的共识方法，对接受CRS和HIPEC治疗的患者的围手术期护理进行标准化。
我们采用了两阶段的改良德尔菲法，涉及一个由40名专家组成的多学科小组，他们完成了一项关于CRS和HIPEC的调查。在一次共识会议上，讨论了调查结果和现有的科学证据。在第二轮调查中，对未达成共识（<75%同意）的项目进行了调整和评估。
在第一轮中，51%的项目达成了共识。经过两轮，大多数项目（82%）达成了共识，包括患者选择、术前检查、CRS和HIPEC的技术方面以及术后护理。对于HIPEC在罕见卵巢癌类型中的作用、术前肠道准备、肠道吻合的时机以及灌注液的处理，未达成共识。
荷兰专家在关于卵巢癌间歇性CRS和HIPEC的大多数项目上达成了共识。这项共识研究可能有助于使治疗方案趋于一致，并尽量减少实践差异。未达成共识的主题可能会被列入卵巢癌HIPEC的研究议程。
