Guidelines for Perioperative Care in Cytoreductive Surgery (CRS) with or without hyperthermic IntraPEritoneal chemotherapy (HIPEC): Enhanced recovery after surgery (ERAS®) Society Recommendations — Part I: Preoperative and intraoperative management

Martin Hübner, Shigeki Kusamura, Laurent Villeneuve, Ahmed Al-Niaimi, Mohammad Alyami, Konstantin Balonov, John Bell, Robert Bristow, Delia Cortés Guiral, Anna Fagotti, Luiz Fernando R. Falcão, Olivier Glehen, Laura Lambert, Lloyd Mack, Tino Muenster, Pompiliu Piso, Marc Pocard, Beate Rau, Olivia Sgarbura, S. P. somashekharAnupama Wadhwa, Alon Altman, William Fawcett, Jula Veerapong, Gregg Nelson

Research output: Contribution to journalArticlepeer-review

Abstract

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 I of the guidelines highlights preoperative and intraoperative management. 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.

Original languageEnglish (US)
Pages (from-to)2292-2310
Number of pages19
JournalEuropean Journal of Surgical Oncology
Volume46
Issue number12
DOIs
StatePublished - Dec 2020
Externally publishedYes

Keywords

  • Cytoreductive surgery
  • Enhanced recovery
  • Guidelines
  • HIPEC
  • Perioperative care

ASJC Scopus subject areas

  • Surgery
  • Oncology

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