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.

{"article_title":"Guidelines for Perioperative Care in Cytoreductive Surgery (CRS) with or without hyperthermic IntraPEritoneal chemotherapy (HIPEC): Enhanced Recovery After Surgery (ERAS\u00ae) Society Recommendations - Part II: Postoperative management and special considerations.","author":"H\u00fcbner M, Kusamura S, Villeneuve L, Al-Niaimi A, Alyami M, Balonov K, Bell J, Bristow R, Guiral DC, Fagotti A, Falc\u00e3o LFR, Glehen O, Lambert L, Mack L, Muenster T, Piso P, Pocard M, Rau B, Sgarbura O, Somashekhar SP, Wadhwa A, Altman A, Fawcett W, Veerapong J, Nelson G","journal_title":"European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology","issn":"1532-2157","isbn":"","publication_date":"2020-12-01","volume":"46","issue":"12","first_page":"2311","page_count":"","accession_number":"32826114","doi":"10.1016\/j.ejso.2020.08.006","publisher":"Elsevier","doctype":"Journal Article","subjects":"Cytoreduction Surgical Procedures adverse effects; Cytoreduction Surgical Procedures standards; Enhanced Recovery After Surgery standards; Hyperthermic Intraperitoneal Chemotherapy adverse effects; Hyperthermic Intraperitoneal Chemotherapy standards; Peritoneal Neoplasms therapy; Postoperative Care standards; Combined Modality Therapy; Delphi Technique; Humans; Peritoneal Neoplasms surgery; Postoperative Complications prevention & control; Postoperative Period","interest_area":["Oncology"],"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) \u00b1 hyperthermic intraperitoneal chemotherapy (HIPEC) in a two-part series of guidelines based on expert consensus. The present part II of the guidelines highlights postoperative management and special considerations. 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 \u226550%, or \u226570% 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 \u00b1 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 \u00b1 HIPEC and to prospectively evaluate recommendations in clinical practice. Competing Interests: Declaration of competing interest GN is Secretary of the ERAS\u00ae Society (no financial conflicts). Copyright \u00a9 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.","url":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&db=mdl&AN=32826114","isPdfLink":false,"isSAML":false,"an":"32826114","number_other":"","type_pub":"","issn_electronic":"1532-2157","languages":"English","language":"eng","date_entry":"Date Created: 20200823 Date Completed: 20210301 Latest Revision: 20210301","date_update":"20240105","titleSource":"European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2020 Dec; Vol. 46 (12), pp. 2311-2323. Date of Electronic Publication: 2020 Aug 13.","date_pub_cy":"","type_document":"","contract_publisher":"","authored_on":"2020-12-01","description":"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 II of the guidelines highlights postoperative management and special considerations.<br \/>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 \u226550%, or \u226570% of weak\/strong recommendations combined) was reached by a standardised 2-round Delphi process, regarding the strength of recommendations.<br \/>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.<br \/>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.<br \/>Competing Interests: Declaration of competing interest GN is Secretary of the ERAS® Society (no financial conflicts).<br \/> (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)","upload_link":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&scope=site&db=mdl&AN=32826114&authtype=shib&custid=ns346513&group=main&profile=eds","no_of_pages":"","authored_by":"H\u00fcbner M, Kusamura S, Villeneuve L, Al-Niaimi A, Alyami M, Balonov K, Bell J, Bristow R, Guiral DC, Fagotti A, Falc\u00e3o LFR, Glehen O, Lambert L, Mack L, Muenster T, Piso P, Pocard M, Rau B, Sgarbura O, Somashekhar SP, Wadhwa A, Altman A, Fawcett W, Veerapong J, Nelson G"}