成功实施增强术后恢复（ERAS）方案对接受细胞减灭手术和热灌注化疗（CRS/HIPEC）患者的影响
Impact of Successful Implementation of an Enhanced Recovery After Surgery Protocol for Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
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影响因子:3.5
分区:医学2区 / 外科2区 肿瘤学3区
发表日期:2023 Dec
作者:
Beatrice J Sun, Tiffany M Yue, Nova Xu, Cedar Fowler, Byrne Lee
DOI:
10.1245/s10434-023-14222-8
摘要
细胞减灭手术和热灌注化疗（CRS/HIPEC）是治疗腹膜转移的复杂手术。增强术后恢复（ERAS）方案旨在标准化术前、术中和术后流程，以改善患者护理。本研究描述在三级学术中心实施ERAS方案后，手术的可行性与效果。回顾了2020年1月至2023年3月期间单一机构的CRS/HIPEC经验。根据患者是否在ERAS启动前后接受手术，将其分类。评估了手术结果与方案依从性。共纳入115例CRS/HIPEC手术——ERAS前74例，ERAS后41例。ERAS后组患者的中位年龄较年轻，但性别、合并症、腹膜癌症指数、手术类型和手术时间在两组间相似。最常见的原发癌部位为妇科（40%）、阑尾（24%）和结直肠（22%）。所有术后ERAS组成部分的依从率为76%。ERAS后组患者在术后第1天（90%对54%；p<0.001）即可活动、在第2天（88%对32%；p<0.001）耐受液体饮食，以及第3天（86%对43%；p<0.001）拔导尿管的比例均显著更高。ERAS后组的住院天数呈下降趋势（7天对8天；p=0.092），但两组在重大并发症、重症监护室入院率或30天再入院率方面无显著差异。尽管CRS/HIPEC手术异质性较大，实施ERAS方案对于患者是可行的，并在术后结果和依从性方面与其他重大腹部手术相当。这支持了CRS/HIPEC患者ERAS项目成功的潜力。
Abstract
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) are complex operations for the treatment of peritoneal metastases. Enhanced recovery after surgery (ERAS) protocols are intended to standardize preoperative, intraoperative, and postoperative pathways, with the goal of improving patient care. This study describes feasibility and outcomes after implementing an ERAS protocol for CRS/HIPEC at a tertiary academic center.A single-institution experience of CRS/HIPEC was reviewed from January 2020 to March 2023. Patients were categorized according to whether they underwent CRS/HIPEC before or after ERAS initiation. Outcomes and protocol adherence were evaluated.A total of 115 CRS/HIPEC operations were included-74 before and 41 after ERAS implementation. Median age was younger in the post-ERAS group, whereas sex, comorbidities, peritoneal carcinomatosis index, operation performed, and operative time were similar between groups. The most common primary cancer sites were gynecologic (40%), appendiceal (24%), and colorectal (22%). Adherence to all postoperative ERAS components was 76%. More post-ERAS patients ambulated by postoperative day (POD) 1 (90% vs. 54%; p < 0.001), tolerated liquid diet by POD 2 (88% vs. 32%; p < 0.001), and had foley removed by POD 3 (86% vs. 43%; p < 0.001). There was a trend toward decreased length of stay in the post-ERAS cohort (7 vs. 8 days; p = 0.092), with no difference in major complications, intensive care unit admission, or 30-day readmission.Despite the heterogeneity of CRS/HIPEC operations, implementing an ERAS protocol for our patients was feasible and resulted in postoperative outcomes and adherence comparable with that of other major abdominal surgeries. This supports the potential for success in ERAS programs for CRS/HIPEC patients.