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. 2021 Jan 8;5(1):zraa055.
doi: 10.1093/bjsopen/zraa055.

Perioperative management and anaesthetic considerations in pelvic exenterations using Delphi methodology: results from the PelvEx Collaborative

PelvEx Collaborative
Collaborators

Perioperative management and anaesthetic considerations in pelvic exenterations using Delphi methodology: results from the PelvEx Collaborative

PelvEx Collaborative. BJS Open. .

Abstract
in English, Spanish

Background: The multidisciplinary perioperative and anaesthetic management of patients undergoing pelvic exenteration is essential for good surgical outcomes. No clear guidelines have been established, and there is wide variation in clinical practice internationally. This consensus statement consolidates clinical experience and best practice collectively, and systematically addresses key domains in the perioperative and anaesthetic management.

Methods: The modified Delphi methodology was used to achieve consensus from the PelvEx Collaborative. The process included one round of online questionnaire involving controlled feedback and structured participant response, two rounds of editing, and one round of web-based voting. It was held from December 2019 to February 2020. Consensus was defined as more than 80 per cent agreement, whereas less than 80 per cent agreement indicated low consensus.

Results: The final consensus document contained 47 voted statements, across six key domains of perioperative and anaesthetic management in pelvic exenteration, comprising preoperative assessment and preparation, anaesthetic considerations, perioperative management, anticipating possible massive haemorrhage, stress response and postoperative critical care, and pain management. Consensus recommendations were developed, based on consensus agreement achieved on 34 statements.

Conclusion: The perioperative and anaesthetic management of patients undergoing pelvic exenteration is best accomplished by a dedicated multidisciplinary team with relevant domain expertise in the setting of a specialized tertiary unit. This consensus statement has addressed key domains within the framework of current perioperative and anaesthetic management among patients undergoing pelvic exenteration, with an international perspective, to guide clinical practice, and has outlined areas for future clinical research.

Antecedentes: El manejo perioperatorio y anestésico multidisciplinario de los pacientes sometidos a una exenteración pélvica (EP) es esencial para obtener buenos resultados quirúrgicos. No se han establecido pautas claras y existe una amplia variación en la práctica clínica a nivel internacional. Esta declaración de consenso consolida la experiencia clínica y las mejores prácticas de manera colectiva, y aborda sistemáticamente los dominios clave en el manejo perioperatorio y anestésico.

Métodos: Se utilizó la metodología Delphi modificada para lograr el consenso en el grupo PelvEx Collaborative. El proceso incluyó una ronda de cuestionario en línea (online) que incluía comentarios controlados y una respuesta estructurada de los participantes, dos rondas de edición y una ronda de votación en línea. Se llevó a cabo de diciembre de 2019 a febrero de 2020. El consenso se definió como un acuerdo de más del 80%; menos del 80% de acuerdo indicó un bajo consenso.

Resultados: El documento de consenso final contenía 47 declaraciones votadas, en seis dominios clave del manejo perioperatorio y anestésico en las EP, que comprendían evaluación y preparación preoperatorias, consideraciones anestésicas, manejo perioperatorio, anticipación de posibles hemorragias masivas, respuesta al estrés y cuidados críticos posoperatorios y manejo del dolor. Las recomendaciones de consenso se desarrollaron sobre la base del acuerdo de consenso alcanzado en 34 declaraciones.

Conclusión: El manejo perioperatorio y anestésico de los pacientes con EP mejora mediante un equipo multidisciplinario dedicado con experiencia en los dominios relevantes en el marco de una unidad terciaria especializada. Bajo una perspectiva internacional, esta declaración de consenso ha abordado dominios clave del marco del actual del manejo perioperatorio y anestésico de pacientes con EP como guía de la práctica clínica y ha definido áreas para la investigación clínica futura.

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