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 Hübner¹, Shigeki Kusamura², Laurent Villeneuve³, Ahmed Al-Niaimi⁴, Mohammad Alyami⁵, Konstantin Balonov⁶, John Bell⁷, Robert Bristow⁸, Delia Cortés Guiral⁹, Anna Fagotti¹⁰, Luiz Fernando R Falcão¹¹, Olivier Glehen¹², Laura Lambert¹³, Lloyd Mack¹⁴, Tino Muenster¹⁵, Pompiliu Piso¹⁶, Marc Pocard¹⁷, Beate Rau¹⁸, Olivia Sgarbura¹⁹, S P Somashekhar²⁰, Anupama Wadhwa²¹, Alon Altman²², William Fawcett²³, Jula Veerapong²⁴, Gregg Nelson²⁵

Affiliations

¹ Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Switzerland. Electronic address: martin.hubner@chuv.ch.
² Peritoneal Surface Malignancy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
³ Clinical Research and Epidemiological Unit, Department of Public Health, Lyon University Hospital, EA 3738, University of Lyon, Lyon, France.
⁴ Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, USA.
⁵ Department of General Surgery and Surgical Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
⁶ Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, USA.
⁷ Department of Anesthesiology, Basingstoke and North Hampshire Hospital, Basingstoke, UK.
⁸ Department of Obstetrics and Gynecologic Oncology, University of California, Irvine School of Medicine, Orange, USA.
⁹ Department of General Surgery (Peritoneal Surface Surgical Oncology). University Hospital Principe de Asturias, Alcalá de Henares, Madrid, Spain.
¹⁰ Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Catholic University of the Sacred Heart, 00168, Rome, Italy.
¹¹ Discipline of Anesthesiology, Pain and Critical Care Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil.
¹² Department of Digestive Surgery, Lyon University Hospital, EA 3738, University of Lyon, Lyon, France.
¹³ Peritoneal Surface Malignancy Program, Section of Surgical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
¹⁴ Department of Surgical Oncology, University of Calgary, Calgary, Alberta, Canada.
¹⁵ Department of Anaesthesiology and Intensive Care Medicine. Hospital Barmherzige Brüder, Regensburg, Germany.
¹⁶ Department of General and Visceral Surgery, Hospital Barmherzige Brüder, Regensburg, Germany.
¹⁷ Department of Digestive Surgery, Lariboisière University Hospital, Paris, France.
¹⁸ Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Germany.
¹⁹ Department of Surgical Oncology, Cancer Institute Montpellier (ICM), University of Montpellier, Montpellier, France.
²⁰ Department of Surgical Oncology, Manipal Comprehensive Cancer Centre, Manipal Hospital, Bengaluru, India.
²¹ Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA.
²² Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Canada.
²³ Anaesthesia and Pain Medicine, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK.
²⁴ Department of Surgery, Division of Surgical Oncology, University of California San Diego, La Jolla, CA, USA.
²⁵ Division of Gynecologic Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada.

PMID: 32873454
DOI: 10.1016/j.ejso.2020.07.041

Free article

Practice Guideline

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 et al. Eur J Surg Oncol. 2020 Dec.

Free article

. 2020 Dec;46(12):2292-2310.

doi: 10.1016/j.ejso.2020.07.041. Epub 2020 Aug 25.

Authors

Affiliations

¹ Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Switzerland. Electronic address: martin.hubner@chuv.ch.
² Peritoneal Surface Malignancy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
³ Clinical Research and Epidemiological Unit, Department of Public Health, Lyon University Hospital, EA 3738, University of Lyon, Lyon, France.
⁴ Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, USA.
⁵ Department of General Surgery and Surgical Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
⁶ Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, USA.
⁷ Department of Anesthesiology, Basingstoke and North Hampshire Hospital, Basingstoke, UK.
⁸ Department of Obstetrics and Gynecologic Oncology, University of California, Irvine School of Medicine, Orange, USA.
⁹ Department of General Surgery (Peritoneal Surface Surgical Oncology). University Hospital Principe de Asturias, Alcalá de Henares, Madrid, Spain.
¹⁰ Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Catholic University of the Sacred Heart, 00168, Rome, Italy.
¹¹ Discipline of Anesthesiology, Pain and Critical Care Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil.
¹² Department of Digestive Surgery, Lyon University Hospital, EA 3738, University of Lyon, Lyon, France.
¹³ Peritoneal Surface Malignancy Program, Section of Surgical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
¹⁴ Department of Surgical Oncology, University of Calgary, Calgary, Alberta, Canada.
¹⁵ Department of Anaesthesiology and Intensive Care Medicine. Hospital Barmherzige Brüder, Regensburg, Germany.
¹⁶ Department of General and Visceral Surgery, Hospital Barmherzige Brüder, Regensburg, Germany.
¹⁷ Department of Digestive Surgery, Lariboisière University Hospital, Paris, France.
¹⁸ Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Germany.
¹⁹ Department of Surgical Oncology, Cancer Institute Montpellier (ICM), University of Montpellier, Montpellier, France.
²⁰ Department of Surgical Oncology, Manipal Comprehensive Cancer Centre, Manipal Hospital, Bengaluru, India.
²¹ Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA.
²² Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Canada.
²³ Anaesthesia and Pain Medicine, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK.
²⁴ Department of Surgery, Division of Surgical Oncology, University of California San Diego, La Jolla, CA, USA.
²⁵ Division of Gynecologic Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada.

PMID: 32873454
DOI: 10.1016/j.ejso.2020.07.041

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.

Keywords: Cytoreductive surgery; Enhanced recovery; Guidelines; HIPEC; Perioperative care.

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Conflict of interest statement

Declaration of competing interest All other authors declare to have no disclosures.This information has been provided by all authors individually in their attached author forms with date and signatures.

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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 I: Preoperative and intraoperative management

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical