TY - JOUR
T1 - Guidelines for Perioperative Care in Cytoreductive Surgery (CRS) with or without hyperthermic IntraPEritoneal chemotherapy (HIPEC)
T2 - Enhanced Recovery After Surgery (ERAS®) Society Recommendations — Part II: Postoperative management and special considerations
AU - Hübner, Martin
AU - Kusamura, Shigeki
AU - Villeneuve, Laurent
AU - Al-Niaimi, Ahmed
AU - Alyami, Mohammad
AU - Balonov, Konstantin
AU - Bell, John
AU - Bristow, Robert
AU - Guiral, Delia Cortés
AU - Fagotti, Anna
AU - Falcão, Luiz Fernando R.
AU - Glehen, Olivier
AU - Lambert, Laura
AU - Mack, Lloyd
AU - Muenster, Tino
AU - Piso, Pompiliu
AU - Pocard, Marc
AU - Rau, Beate
AU - Sgarbura, Olivia
AU - Somashekhar, S. P.
AU - Wadhwa, Anupama
AU - Altman, Alon
AU - Fawcett, William
AU - Veerapong, Jula
AU - Nelson, Gregg
N1 - Publisher Copyright:
© 2020 The Authors
PY - 2020/12
Y1 - 2020/12
N2 - Background: Enhanced recovery after surgery (ERAS) pathways have been shown to considerably reduce complications, length of stay and costs after most of surgical procedures by standardised application of best evidence-based perioperative care. The aim was to elaborate dedicated recommendations for cytoreductive surgery (CRS) ± hyperthermic intraperitoneal chemotherapy (HIPEC) in a two-part series of guidelines based on expert consensus. The present part II of the guidelines highlights postoperative management and special considerations. Methods: The core group assembled a multidisciplinary panel of 24 experts involved in peritoneal surface malignancy surgery representing the fields of general surgery (n = 12), gynaecological surgery (n = 6), and anaesthesia (n = 6). Experts systematically reviewed and summarized the available evidence on 72 identified perioperative care items, following the GRADE (grading of recommendations, assessment, development, evaluation) system. Final consensus (defined as ≥50%, or ≥70% of weak/strong recommendations combined) was reached by a standardised 2-round Delphi process, regarding the strength of recommendations. Results: Response rates were 100% for both Delphi rounds. Quality of evidence was evaluated high, moderate low and very low, for 15 (21%), 26 (36%), 29 (40%) and 2 items, respectively. Consensus was reached for 71/72(98.6%) items. Strong recommendations were defined for 37 items. No consensus could be reached regarding the preemptive use of fresh frozen plasma. Conclusion: The present ERAS recommendations for CRS ± HIPEC are based on a standardised expert consensus process providing clinicians with valuable guidance. There is an urgent need to produce high quality studies for CRS ± HIPEC and to prospectively evaluate recommendations in clinical practice.
AB - Background: Enhanced recovery after surgery (ERAS) pathways have been shown to considerably reduce complications, length of stay and costs after most of surgical procedures by standardised application of best evidence-based perioperative care. The aim was to elaborate dedicated recommendations for cytoreductive surgery (CRS) ± hyperthermic intraperitoneal chemotherapy (HIPEC) in a two-part series of guidelines based on expert consensus. The present part II of the guidelines highlights postoperative management and special considerations. Methods: The core group assembled a multidisciplinary panel of 24 experts involved in peritoneal surface malignancy surgery representing the fields of general surgery (n = 12), gynaecological surgery (n = 6), and anaesthesia (n = 6). Experts systematically reviewed and summarized the available evidence on 72 identified perioperative care items, following the GRADE (grading of recommendations, assessment, development, evaluation) system. Final consensus (defined as ≥50%, or ≥70% of weak/strong recommendations combined) was reached by a standardised 2-round Delphi process, regarding the strength of recommendations. Results: Response rates were 100% for both Delphi rounds. Quality of evidence was evaluated high, moderate low and very low, for 15 (21%), 26 (36%), 29 (40%) and 2 items, respectively. Consensus was reached for 71/72(98.6%) items. Strong recommendations were defined for 37 items. No consensus could be reached regarding the preemptive use of fresh frozen plasma. Conclusion: The present ERAS recommendations for CRS ± HIPEC are based on a standardised expert consensus process providing clinicians with valuable guidance. There is an urgent need to produce high quality studies for CRS ± HIPEC and to prospectively evaluate recommendations in clinical practice.
KW - Cytoreductive surgery
KW - Enhanced recovery
KW - Guidelines
KW - HIPEC
KW - Perioperative care
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U2 - 10.1016/j.ejso.2020.08.006
DO - 10.1016/j.ejso.2020.08.006
M3 - Article
C2 - 32826114
AN - SCOPUS:85089525297
SN - 0748-7983
VL - 46
SP - 2311
EP - 2323
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 12
ER -