Guidelines for Perioperative Care in Cytoreductive Surgery (CRS) with or without hyperthermic IntraPEritoneal chemotherapy (HIPEC): Enhanced Recovery After Surgery (ERAS®) Society Recommendations — Part II: Postoperative management and special considerations

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

doi:10.1016/j.ejso.2020.08.006

Cited by 88 publications

(56 citation statements)

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“…Indeed, goal-directed intraoperative fluids as part of the ERAS program were used by all included studies in this review while patient education was utilized by five of the six studies. Important to note is that detailed ERAS guidelines specific to CRS + HIPEC have been made available only recently much after the conduct of the included studies ( 32 , 33 ). Hubner et al ( 32 , 33 ) in August 2020 provided several preoperative, intraoperative, and postoperative recommendations for CRS + HIPEC, focusing on the core tenants of the ERAS program mentioned earlier.…”

Section: Discussionmentioning

confidence: 99%

“…Important to note is that detailed ERAS guidelines specific to CRS + HIPEC have been made available only recently much after the conduct of the included studies ( 32 , 33 ). Hubner et al ( 32 , 33 ) in August 2020 provided several preoperative, intraoperative, and postoperative recommendations for CRS + HIPEC, focusing on the core tenants of the ERAS program mentioned earlier. However, of the 72 items on the list, direct evidence was available only for eight items and the rest were extrapolated from other related colorectal and abdominal surgical procedures.…”

Section: Discussionmentioning

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: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

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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“…In recent years, standards for perioperative care, such as enhanced recovery after surgery (ERAS) guidelines, have been promoted to reduce the length of hospital stay, costs, and complication rates. 23,24 First published studies in CRS and HIPEC patients show some promising results; however, there was no impact on AKI rates. [25][26][27] In our own cohort, fluid management was guided by our SOP for all patients (STS or no STS) and was restrictive after the day of surgery.…”

Section: Discussionmentioning

confidence: 99%

Sodium Thiosulfate Reduces Acute Kidney Injury in Patients Undergoing Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy with Cisplatin: A Single-Center Observational Study

et al. 2021

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Background Cytoreductive surgery (CRS) in combination with hyperthermic intraperitoneal chemotherapy (HIPEC) represents a multimodal treatment concept for patients with peritoneal surface malignancies. The use of intraperitoneal cisplatin (CDDP) is associated with a risk of acute kidney injury (AKI). The aim of this study is to evaluate the protective effect of perioperative sodium thiosulfate (STS) administration on kidney function in patients undergoing CRS and CDDP-based HIPEC. Patients and Methods We retrospectively analyzed clinical data of all patients who underwent CRS and CDDP-based HIPEC at our hospital between March 2017 and August 2020. Patients were stratified according to the use of sodium thiosulfate (STS vs. no STS). We compared kidney function and clinical outcome parameters between both groups and determined risk factors for postoperative AKI on univariate and multivariate analysis. AKI was classified according to acute kidney injury network (AKIN) criteria. Results Of 238 patients who underwent CRS and CDDP-based HIPEC, 46 patients received STS and 192 patients did not. There were no significant differences in baseline characteristics. In patients who received STS, a lower incidence (6.5% vs. 30.7%; p = 0.001) and severity of AKI (p = 0.009) were observed. On multivariate analysis, the use of STS (OR 0.089, p = 0.001) remained an independent kidney-protective factor, while arterial hypertension (OR 5.283, p < 0.001) and elevated preoperative urea serum level (OR 5.278, p = 0.032) were predictors for postoperative AKI. Conclusions The present data suggest that STS protects patients from AKI caused by CRS and CDDP-based HIPEC. Further prospective studies are needed to validate the benefit of STS among kidney-protective strategies.

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“…The questionnaire was designed based on existing ERAS guidelines on colorectal and gynecological cancer surgery and comprised both open-ended and close-ended questions. ERAS guidelines specific to CRS-HIPEC were not available at the time this survey was conceptualized and were published subsequently [ 16 , 17 ]. Several perioperative aspects specific to CRS-HIPEC and ERAS pathways were incorporated in the questionnaire ( Supplementary Material 1 ).…”

Section: Methodsmentioning

confidence: 99%

Enhanced recovery after surgery (ERAS) in cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC): a cross-sectional survey

Bhandoria

Solanki

Bhavsar

et al. 2021

Pleura and Peritoneum

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Objectives Enhanced recovery after surgery (ERAS) protocols have been questioned in patients undergoing cytoreductive surgery (CRS) with/without hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal malignancies. This survey was performed to study clinicians’ practice about ERAS in patients undergoing CRS-HIPEC. Methods An online survey, comprising 76 questions on elements of prehabilitation (n=11), preoperative (n=8), intraoperative (n=16) and postoperative (n=32) management, was conducted. The respondents included surgeons, anesthesiologists, and critical care specialists. Results The response rate was 66% (136/206 clinicians contacted). Ninety-one percent of respondents reported implementing ERAS practices. There was encouraging adherence to implement the prehabilitation (76–95%), preoperative (50–94%), and intraoperative (55–90%) ERAS practices. Mechanical bowel preparation was being used by 84.5%. Intra-abdominal drains usage was 94.7%, intercostal drains by 77.9% respondents. Nasogastric drainage was used by 84% of practitioners. The average hospital stay was 10 days as reported by 50% of respondents. A working protocol and ERAS checklist have been designed, based on the results of our study, following recent ERAS-CRS-HIPEC guidelines. This protocol will be prospectively validated. Conclusions Most respondents were implementing ERAS practices for patients undergoing CRS-HIPEC, though as an extrapolation of colorectal and gynecological guidelines. The adoption of postoperative practices was relatively low compared to other perioperative practices.

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Guidelines for Perioperative Care in Cytoreductive Surgery (CRS) with or without hyperthermic IntraPEritoneal chemotherapy (HIPEC): Enhanced Recovery After Surgery (ERAS®) Society Recommendations — Part II: Postoperative management and special considerations

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

Cited by 88 publications

References 112 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

Sodium Thiosulfate Reduces Acute Kidney Injury in Patients Undergoing Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy with Cisplatin: A Single-Center Observational Study

Enhanced recovery after surgery (ERAS) in cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC): a cross-sectional survey

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