Cytoreductive Surgery and HIPEC in an Enhanced Recovery After Surgery Program: A Feasibility Study

Lu, Pamela; Fields, Adam C.; Shabat, Galyna; Bleday, Ronald; Goldberg, Joel; Irani, Jennifer; Stopfkuchen-Evans, Matthias

doi:10.1016/j.jss.2019.10.042

Cited by 21 publications

(12 citation statements)

References 25 publications

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“…After deduplication, 125 unique records were screened of which 113 were excluded after title/abstract screening. From the remaining 12 articles, six were excluded after full-text analysis with reasons, and a total of six studies were included for this review ( 18 , 19 , 25 – 28 ).…”

Section: Resultsmentioning

confidence: 99%

“…While researchers have used some components of ERAS like pre-habilitation or restrictive fluid therapy for patients undergoing CRS + HIPEC ( 16 , 17 ), the impact of a comprehensive ERAS protocol on these patients is still unclear. In the past 3 years, some researchers have presented their experience of ERAS with CRS + HIPEC but with a limited sample size ( 18 , 19 ). To the best of our knowledge, no review has been attempted to synthesize data from these studies to present the best available evidence regarding the impact of ERAS on CRS + HIPEC.…”

Section: Introductionmentioning

confidence: 99%

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Enhanced Recovery After Surgery for Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Systematic Review and Meta-Analysis

Mao¹,

Zhenmin²

2021

Front. Surg.

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Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a promising approach for the management of peritoneal carcinomatosis, but is associated with significant morbidity and prolonged hospital stay. Herein, we review the impact of Enhanced recovery after surgery (ERAS) protocol on length of stay (LOS) and early complications in patients undergoing CRS and HIPEC for peritoneal carcinomatosis.Methods: PubMed and Embase were searched for studies comparing ERAS protocol with control for CRS + HIPEC. Mean difference (MD) and risk ratios (RR) were calculated for LOS and complications respectively.Results: Six retrospective studies were included. Meta-analysis indicated statistically significant reduction in LOS with ERAS (MD: −2.82 95% CI: −3.79, −1.85 I2 = 29% p < 0.00001). Our results demonstrated significantly reduced risk of Calvien Dindo grade III/IV complications with the use of ERAS protocol as compared to the control group (RR: 0.60 95% CI: 0.41, 0.87 I2 = 0% p = 0.007). Pooled analysis of limited studies demonstrated no statistically significant difference in the risk of reoperation (RR: 1.04 95% CI: 0.54, 2.03 I2 = 50% p = 0.90) readmission (RR: 0.55 95% CI: 0.21, 1.49 I2 = 0% p = 0.24), acute kidney injury (RR: 0.55 95% CI: 0.28, 1.10 I2 = 0% p = 0.09) or mortality (RR: 0.62 95% CI: 0.17, 2.26 I2 = 0% p = 0.46) between the study groups.Conclusion: For CRS + HIPEC, ERAS is associated with significantly reduced LOS along with lower incidence of complications. Limited data suggest that use of ERAS protocol is not associated with increased readmission, reoperation, and mortality rates in these patients. There is a need for randomized controlled trials to corroborate the current evidence.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Enhanced Recovery After Surgery for Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Systematic Review and Meta-Analysis

Mao¹,

Zhenmin²

2021

Front. Surg.

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“…Rate of 30-day readmission or reoperation reported in 13 studies [ 9 – 12 , 15 , 17 , 25 – 30 , 32 ] and mortality in 8 studies [ 11 , 12 , 14 , 15 , 25 , 26 , 30 , 32 ]. 11 studies adopted the fluid management mode of goal-directed fluid therapy (GDFT) [ 10 – 17 , 27 , 29 , 30 ], 6 studies used restrictive fluid management intraoperatively [ 9 , 25 , 26 , 28 , 33 , 34 ], and the remaining 2 studies [ 31 , 32 ] did not elaborate the fluid management mode. Ten studies [ 9 , 10 , 12 – 15 , 29 , 31 , 33 , 34 ] adopted the KDIGO criteria to evaluate AKI, which 1.5 times the preoperative baseline value within 30 days after operation based on the latest clinical guidelines from the Kidney Disease: Improving Global Outcomes (KDIGO) criteria [ 35 ].…”

Section: Resultsmentioning

confidence: 99%

“…11 studies adopted the fluid management mode of goal-directed fluid therapy (GDFT) [ 10 – 17 , 27 , 29 , 30 ], 6 studies used restrictive fluid management intraoperatively [ 9 , 25 , 26 , 28 , 33 , 34 ], and the remaining 2 studies [ 31 , 32 ] did not elaborate the fluid management mode. Ten studies [ 9 , 10 , 12 – 15 , 29 , 31 , 33 , 34 ] adopted the KDIGO criteria to evaluate AKI, which 1.5 times the preoperative baseline value within 30 days after operation based on the latest clinical guidelines from the Kidney Disease: Improving Global Outcomes (KDIGO) criteria [ 35 ]. Four studies [ 11 , 16 , 17 , 30 ] adopted RIFLE (Risk, Injury, Failure, Loss, and End-stage renal disease classification) [ 36 ], EPCO (European Perioperative Clinical Outcome definitions) [ 37 ], and NSQIP (National Surgical Quality Improvement Program) [ 38 ] criteria to define the occurrence of AKI respectively and the remaining 5 studies [ 25 – 28 , 32 ] did not mention the evaluation criteria for AKI.…”

Section: Resultsmentioning

confidence: 99%

“…Our initial search yielded 7,441 potentially relevant cohort studies on postoperative complications including AKI occurring with ERAS versus conventional therapy in patients who underwent surgery. After screening and reviewing, 19 studies [9][10][11][12][13][14][15][16][17][25][26][27][28][29][30][31][32][33][34] met our inclusion criteria. Of the nineteen, seventeen were retrospective and two were prospective cohort studies.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

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Impact of Enhanced Recovery After Surgery (ERAS) protocol versus standard of care on postoperative Acute Kidney Injury (AKI): A meta-analysis

Shen

Wang

et al. 2021

PLoS ONE

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Background Acute kidney injury (AKI) is a common postoperative complication with an incidence of nearly 15%. Relatively balanced fluid management, flexible use of vasoactive drugs, multimodal analgesia containing non-steroidal anti-inflammatory drugs are fundamental to ERAS protocols. However, these basic tenants may lead to an increased incidence of postoperative AKI. Methods A search was done in the PubMed, Embase, Cochrane Library and reference lists to identify relevant studies from inception until May 2020 to be included in this study. Effects were summarized using pooled risk ratios (RRs), mean differences (MDs) and corresponding 95% confidence intervals (Cls) with random effect model. Heterogeneity assessment, sensitivity analysis, and publication bias were performed. Results A systematic review of nineteen cohort studies covering 17,205 patients, comparing impact of ERAS with conventional care on postoperative AKI was performed. Notably, the ERAS regimen did not increase the incidence of postoperative AKI compared with standard care (RR: 1.21; 95% CI: 0.96 to 1.52; I2 = 53%). Both goal-directed fluid therapy (RR: 1.26; 95% CI: 0.99–1.61; I2 = 55%) and restrictive fluid management (RR: 1.06; 95% CI: 0.57–1.98; I2 = 60%) had no significant effect on the incidence of postoperative AKI. There was no significant statistical difference between different AKI diagnostic criteria (P = 0.43; I2 = 0%). ERAS group had significantly shorter hospital stay (MD: −1.54; 95% CI: −1.91 to −1.17; I2 = 66%). There was no statistical difference in 30-day readmission rate (RR: 0.98; 95% CI: 0.80 to 1.20; I2 = 42%), 30-day reoperation rate (RR: 0.98; 95% CI: 0.71 to 1.34; I2 = 42%) and mortality (RR: 0.81; 95% CI: 0.59 to 1.11; I2 = 0%) between the two groups. Conclusions This meta-analysis suggests that ERAS protocols do not increase readmission or reoperation rates and mortality while significantly reducing LOS. Most importantly, the ERAS protocol was shown to have no promoting effect on the incidence of postoperative AKI. Even GDFT and restrictive fluid management cannot avoid the occurrence of postoperative AKI, and the ERAS protocol is still worth recommending and its safety is further confirmed.

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Avoidance of drains and tubes

Shylasree

Bhandoria

2022

The ERAS® Society Handbook for Obstetrics &Amp; Gynecology

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Cytoreductive Surgery and HIPEC in an Enhanced Recovery After Surgery Program: A Feasibility Study

Cited by 21 publications

References 25 publications

Enhanced Recovery After Surgery for Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Systematic Review and Meta-Analysis

Enhanced Recovery After Surgery for Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Systematic Review and Meta-Analysis

Impact of Enhanced Recovery After Surgery (ERAS) protocol versus standard of care on postoperative Acute Kidney Injury (AKI): A meta-analysis

Avoidance of drains and tubes

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