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

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.2020.07.041

Cited by 127 publications

(101 citation statements)

References 202 publications

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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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“…Enhanced Recovery After Surgery (ERAS) Society recommendations, 2020, have provided guidelines for ERAS in cytoreductive surgery with and without HIPEC (CRS±HIPEC) [ 43 ]. It is recommended that preoperative counseling should be indicated routinely to improve quality of life, somatic symptoms, and psychological outcomes.…”

Section: Reviewmentioning

confidence: 99%

Past, Present, and Future of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Ovarian Cancer

Mishra¹,

Singh²,

Ghatage³

2021

Cureus

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Hyperthermic intraperitoneal chemotherapy (HIPEC), along with optimal cytoreductive surgery, has been debated to be a viable option for the treatment of advanced epithelial ovarian cancer with peritoneal carcinomatosis. HIPEC is associated with a direct and improved penetration of chemotherapy drugs into the affected tissue and is associated with fewer systemic side effects. There is no standard protocol for the use of HIPEC in advanced ovarian cancer. Hence, there is controversy over the timing, dose, duration, and efficacy of HIPEC. In this review, the history, technique, current evidence, recommendations, and future directions of HIPEC are discussed.

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“…The procedure exposes the intraperitoneal contents to ambient air for 3-20 h via a generous laparotomy, which in turn may result in surface hypothermia [3]. The extensive surgical dissection during CRS contributes to peritoneal desiccation which, combined with hypothermia, impairs anti-inflammatory and barrier functions resulting in an increased risk of intra-abdominal sepsis and coagulopathy and potentially increased transfusion requirements, cardiac complications and venous thromboembolic events [4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

A phase I, nonrandomized controlled trial demonstrating the novel technique of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy utilizing warm humidified carbon dioxide insufflation

et al. 2021

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Aim:The aim of this work was to report on the safety and feasibility of warm humidified CO 2 (WHCO 2 ) insufflation during cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Method:Ten consecutive patients with histologically confirmed peritoneal cancer were enrolled in this phase I pilot nonrandomized controlled trial. They were alternately assigned to CRS and HIPEC with WHCO 2 versus standard procedure. WHCO 2 was delivered at 10 L/min, a pressure of 4.5 bar, 37ºC and 98% relative humidity during CRS using the HumiGard TM system. HIPEC was performed with an open abdomen using the Coliseum technique at 42ºC for 60 min. All patients were admitted to the intensive care unit and commenced on total parenteral nutrition postoperatively. Surface and core temperatures were measured every 30 min using an infrared camera and nasopharyngeal probe, respectively. Clinicopathological, intra-and postoperative details were collated between groups, and median surface and core temperatures were statistically compared.Results: Surface and core temperatures were generally higher in the WHCO 2 group. Core temperature at 120 and 180 min was significantly higher in the WHCO 2 versus the non-WHCO 2 group (p = 0.028 and 0.008, respectively). There was a significant linear relationship between core and surface temperature at 30, 60, 90, 120, 150 and 180 min (p = 0.033, 0.004, 0.007, 0.021, 0.009 and 0.006, respectively). The peritoneal cancer index was lower but the estimated blood loss was higher in the non-WHCO 2 than the WHCO 2 group. Conclusion:WHCO 2 in CRS and HIPEC appears to be safe and feasible. An appropriately powered phase II trial will be required to determine if WHCO 2 is associated with improved intra-and postoperative outcomes.

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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

Cited by 127 publications

References 202 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

Past, Present, and Future of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Ovarian Cancer

A phase I, nonrandomized controlled trial demonstrating the novel technique of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy utilizing warm humidified carbon dioxide insufflation

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