Department of Surgery, Section of Surgical Oncology, Stanford University School of Medicine, Stanford, CA, USA.
Stanford University School of Medicine, Stanford, CA, USA.
Ann Surg Oncol. 2023 Dec;30(13):8156-8165. doi: 10.1245/s10434-023-14222-8. Epub 2023 Sep 8.
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) are complex operations for the treatment of peritoneal metastases. Enhanced recovery after surgery (ERAS) protocols are intended to standardize preoperative, intraoperative, and postoperative pathways, with the goal of improving patient care. This study describes feasibility and outcomes after implementing an ERAS protocol for CRS/HIPEC at a tertiary academic center.
A single-institution experience of CRS/HIPEC was reviewed from January 2020 to March 2023. Patients were categorized according to whether they underwent CRS/HIPEC before or after ERAS initiation. Outcomes and protocol adherence were evaluated.
A total of 115 CRS/HIPEC operations were included-74 before and 41 after ERAS implementation. Median age was younger in the post-ERAS group, whereas sex, comorbidities, peritoneal carcinomatosis index, operation performed, and operative time were similar between groups. The most common primary cancer sites were gynecologic (40%), appendiceal (24%), and colorectal (22%). Adherence to all postoperative ERAS components was 76%. More post-ERAS patients ambulated by postoperative day (POD) 1 (90% vs. 54%; p < 0.001), tolerated liquid diet by POD 2 (88% vs. 32%; p < 0.001), and had foley removed by POD 3 (86% vs. 43%; p < 0.001). There was a trend toward decreased length of stay in the post-ERAS cohort (7 vs. 8 days; p = 0.092), with no difference in major complications, intensive care unit admission, or 30-day readmission.
Despite the heterogeneity of CRS/HIPEC operations, implementing an ERAS protocol for our patients was feasible and resulted in postoperative outcomes and adherence comparable with that of other major abdominal surgeries. This supports the potential for success in ERAS programs for CRS/HIPEC patients.
细胞减灭术和腹腔热灌注化疗（CRS/HIPEC）是治疗腹膜转移的复杂手术。加速康复外科（ERAS）方案旨在规范术前、术中和术后路径，以改善患者的护理。本研究描述了在一家三级学术中心实施 CRS/HIPEC 的 ERAS 方案的可行性和结果。
回顾了 2020 年 1 月至 2023 年 3 月期间 CRS/HIPEC 的单机构经验。根据患者是否在 ERAS 启动前或启动后接受 CRS/HIPEC，将其分为两组。评估了结果和方案的依从性。
共纳入 115 例 CRS/HIPEC 手术，其中 74 例在 ERAS 实施前，41 例在 ERAS 实施后。在后 ERAS 组中，中位年龄更年轻，而性别、合并症、腹膜癌指数、手术方式和手术时间在两组间相似。最常见的原发癌部位为妇科（40%）、阑尾（24%）和结直肠（22%）。术后 ERAS 所有组成部分的依从率为 76%。更多的后 ERAS 患者在术后第 1 天（POD）1 下床活动（90% vs. 54%；p < 0.001），在 POD 2 时耐受液体饮食（88% vs. 32%；p < 0.001），在 POD 3 时拔除导尿管（86% vs. 43%；p < 0.001）。在后 ERAS 组中，住院时间有缩短的趋势（7 天 vs. 8 天；p = 0.092），但主要并发症、入住重症监护病房和 30 天再入院率无差异。
尽管 CRS/HIPEC 手术存在异质性，但为我们的患者实施 ERAS 方案是可行的，并且术后结果和依从性与其他主要腹部手术相当。这支持了 CRS/HIPEC 患者 ERAS 方案成功的潜力。
