Surgical Oncology Unit, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy.
Surgical Oncology Unit, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy.
Eur J Surg Oncol. 2024 Sep;50(9):108486. doi: 10.1016/j.ejso.2024.108486. Epub 2024 Jun 13.
Cytoreductive surgery (CRS) combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a complex procedure that involves extensive peritoneal and visceral resections followed by intraperitoneal chemotherapy. The Enhanced Recovery After Surgery (ERAS) program aims to achieve faster recovery by maintaining pre-operative organ function and reducing the stress response following surgery. A recent publication introduced dedicated ERAS guidelines for CRS and HIPEC with the aim of extending the benefits to patients with peritoneal surface malignancies.
A survey was conducted among 21 Italian centers specializing in peritoneal surface malignancies (PSM) treatment to assess adherence to ERAS guidelines. The survey covered pre/intraoperative and postoperative ERAS items and explored attitudes towards ERAS implementation.
All centers completed the survey, demonstrating expertise in PSM treatment. However, less than 30 % of centers adopted ERAS protocols despite being aware of dedicated guidelines. Preoperative optimization was common, with variations in bowel preparation methods and fasting periods. Intraoperative normothermia control was consistent, but fluid management practices varied. Postoperative practices, including routine abdominal drain placement and NGT management, varied greatly among centers. The majority of respondents expressed an intention to implement ERAS, citing concerns about feasibility and organizational challenges.
The study concludes that Italian centers specialized in PSM treatment have limited adoption of ERAS protocols for CRS ± HIPEC, despite being aware of guidelines. The variability in practice highlights the need for standardized approaches and further evaluation of ERAS applicability in this complex surgical setting to optimize patient care.
细胞减灭术（CRS）联合腹腔热灌注化疗（HIPEC）是一种复杂的手术，需要广泛的腹膜和内脏切除，然后进行腹腔内化疗。加速康复外科（ERAS）计划旨在通过维持术前器官功能和减少手术后的应激反应来实现更快的康复。最近的一篇出版物介绍了专门针对 CRS 和 HIPEC 的 ERAS 指南，旨在将这些益处扩展到腹膜表面恶性肿瘤患者。
对 21 家专门从事腹膜表面恶性肿瘤（PSM）治疗的意大利中心进行了一项调查，以评估对 ERAS 指南的遵守情况。该调查涵盖了术前/术中及术后 ERAS 项目，并探讨了对 ERAS 实施的态度。
所有中心都完成了调查，展示了他们在 PSM 治疗方面的专业知识。然而，尽管了解专门的指南，但只有不到 30%的中心采用了 ERAS 方案。术前优化是常见的，肠道准备方法和禁食期存在差异。术中体温控制是一致的，但液体管理方法不同。术后实践，包括常规放置腹部引流管和管理 NGT，在中心之间存在很大差异。大多数受访者表示有意实施 ERAS，他们提到了对可行性和组织挑战的担忧。
研究得出结论，尽管了解指南，但意大利专门从事 PSM 治疗的中心对 CRS±HIPEC 的 ERAS 方案的采用有限。实践中的变异性突出表明需要标准化方法，并进一步评估 ERAS 在这种复杂手术环境中的适用性，以优化患者护理。
