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

Abstract

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.

Considerations for multimodal prehabilitation in women with gynaecological cancers: A realist scoping review

“…Although descriptions of the interventions included in the scoping review are limited, our analysis of the contexts, mechanisms, and outcomes for prehabilitation provide useful insights into the factors that need to be considered in the design and implementation of prehabilitation for women with gynaecological cancer. It is now widely understood that the success of a complex intervention depends on the theory underpinning its design (44), which helps to explain the mechanisms underlying patient behaviour, based on what works for them and their circumstances (45). Unfortunately, however, only two interventions found in the present study described the use of theory in their development (26,46).…”

“…The 24 articles included nine registered protocols for randomised controlled trials of prehabilitation interventions (23)(24)(25)(26)(27)(28)(29)(30)(31), six observational studies (of which four were abstracts only) (32)(33)(34)(35)(36)(37), three mixed-methods studies (38)(39)(40), two qualitative studies (41,42), two cross-sectional surveys (43,44), one costeffectiveness analysis (45) and one review (46) (Table 2). 'Last chance to live normally'.…”

“…In another survey of 136 Indian anaesthesiologists, gynaecological oncologists, and intensivists, 76% recommended preoperative exercise and even greater proportion recommended correction of anaemia, smoking cessation, and alcohol consumption. Immunonutrition was the least recommended intervention (44). Interestingly, based on the survey responses, the psychological component of prehabilitation was considered non-essential.…”

Considerations for multimodal prehabilitation in women with gynaecological cancers: a scoping review using realist principles

“…The 24 studies included nine registered protocols for randomised controlled trials of prehabilitation interventions [ 24 – 32 ], six observational studies (of which four were abstracts only) [ 33 – 38 ], three mixed-methods studies [ 39 – 41 ], two qualitative studies [ 42 , 43 ], two cross-sectional surveys [ 44 , 45 ], one cost-effectiveness analysis [ 46 ] and one systematic review [ 47 ] (Table 2 ).…”

“…In another survey of 136 Indian anaesthesiologists, gynaecological oncologists, and intensivists, 76% recommended preoperative exercise and even greater proportion recommended correction of anaemia, smoking cessation, and alcohol consumption. Immunonutrition was the least recommended intervention [ 45 ]. Interestingly, based on the survey responses, the psychological component of prehabilitation was considered non-essential.…”