Abstract：
BACKGROUND: Cytoreductive surgery (CRS) combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a complex procedure that involves extensive peritoneal and visceral resections followed by intraperitoneal chemotherapy. The Enhanced Recovery After Surgery (ERAS) program aims to achieve faster recovery by maintaining pre-operative organ function and reducing the stress response following surgery. A recent publication introduced dedicated ERAS guidelines for CRS and HIPEC with the aim of extending the benefits to patients with peritoneal surface malignancies.
METHODS: A survey was conducted among 21 Italian centers specializing in peritoneal surface malignancies (PSM) treatment to assess adherence to ERAS guidelines. The survey covered pre/intraoperative and postoperative ERAS items and explored attitudes towards ERAS implementation.
RESULTS: All centers completed the survey, demonstrating expertise in PSM treatment. However, less than 30 % of centers adopted ERAS protocols despite being aware of dedicated guidelines. Preoperative optimization was common, with variations in bowel preparation methods and fasting periods. Intraoperative normothermia control was consistent, but fluid management practices varied. Postoperative practices, including routine abdominal drain placement and NGT management, varied greatly among centers. The majority of respondents expressed an intention to implement ERAS, citing concerns about feasibility and organizational challenges.
CONCLUSIONS: The study concludes that Italian centers specialized in PSM treatment have limited adoption of ERAS protocols for CRS ± HIPEC, despite being aware of guidelines. The variability in practice highlights the need for standardized approaches and further evaluation of ERAS applicability in this complex surgical setting to optimize patient care.
METHODS: A survey was conducted among 21 Italian centers specializing in peritoneal surface malignancies (PSM) treatment to assess adherence to ERAS guidelines. The survey covered pre/intraoperative and postoperative ERAS items and explored attitudes towards ERAS implementation.
RESULTS: All centers completed the survey, demonstrating expertise in PSM treatment. However, less than 30 % of centers adopted ERAS protocols despite being aware of dedicated guidelines. Preoperative optimization was common, with variations in bowel preparation methods and fasting periods. Intraoperative normothermia control was consistent, but fluid management practices varied. Postoperative practices, including routine abdominal drain placement and NGT management, varied greatly among centers. The majority of respondents expressed an intention to implement ERAS, citing concerns about feasibility and organizational challenges.
CONCLUSIONS: The study concludes that Italian centers specialized in PSM treatment have limited adoption of ERAS protocols for CRS ± HIPEC, despite being aware of guidelines. The variability in practice highlights the need for standardized approaches and further evaluation of ERAS applicability in this complex surgical setting to optimize patient care.
摘要：
背景：细胞减灭术（CRS）联合腹腔热化疗（HIPEC）是一项复杂的手术，涉及广泛的腹膜和内脏切除，然后进行腹腔内化疗。手术后增强恢复（ERAS）计划旨在通过维持术前器官功能并减少手术后的应激反应来实现更快的恢复。最近的一份出版物介绍了针对CRS和HIPEC的专用ERAS指南，旨在将益处扩展到腹膜表面恶性肿瘤患者。
方法：在意大利21个专门从事腹膜表面恶性肿瘤（PSM）治疗的中心中进行了一项调查，以评估对ERAS指南的依从性。该调查涵盖了术前/术中和术后ERAS项目，并探讨了对ERAS实施的态度。
结果：所有中心都完成了调查，展示PSM治疗的专业知识。然而,尽管了解专门的指南,但仍有不到30%的中心采用了ERAS协议.术前优化是常见的，随着肠道准备方法和禁食时间的变化。术中正常体温控制是一致的，但是流体管理实践各不相同。术后实践,包括常规腹腔引流和NGT管理，各中心之间差异很大。大多数受访者表示打算实施ERAS，引用对可行性和组织挑战的担忧。
结论：该研究得出结论，专门从事PSM治疗的意大利中心对CRS±HIPEC的ERAS方案采用有限，尽管知道指导方针。实践中的可变性凸显了在这种复杂的手术环境中需要标准化方法和进一步评估ERAS适用性以优化患者护理的需求。
方法：在意大利21个专门从事腹膜表面恶性肿瘤（PSM）治疗的中心中进行了一项调查，以评估对ERAS指南的依从性。该调查涵盖了术前/术中和术后ERAS项目，并探讨了对ERAS实施的态度。
结果：所有中心都完成了调查，展示PSM治疗的专业知识。然而,尽管了解专门的指南,但仍有不到30%的中心采用了ERAS协议.术前优化是常见的，随着肠道准备方法和禁食时间的变化。术中正常体温控制是一致的，但是流体管理实践各不相同。术后实践,包括常规腹腔引流和NGT管理，各中心之间差异很大。大多数受访者表示打算实施ERAS，引用对可行性和组织挑战的担忧。
结论：该研究得出结论，专门从事PSM治疗的意大利中心对CRS±HIPEC的ERAS方案采用有限，尽管知道指导方针。实践中的可变性凸显了在这种复杂的手术环境中需要标准化方法和进一步评估ERAS适用性以优化患者护理的需求。
