Implementation of an enhanced recovery program for complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in a referral center: a case control prospective study

Diane Charleux-Muller; Thibaut Fabacher; Benoit Romain; Nicolas Meyer; Cécile Brigand; Jean-Baptiste Delhorme

doi:10.1515/pp-2022-0133

Implementation of an enhanced recovery program for complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in a referral center: a case control prospective study

Pleura Peritoneum. 2023 Jan 11;8(1):11-18. doi: 10.1515/pp-2022-0133. eCollection 2023 Mar.

Authors

Diane Charleux-Muller¹, Thibaut Fabacher², Benoit Romain^{1

3}, Nicolas Meyer², Cécile Brigand¹, Jean-Baptiste Delhorme^{1

3}

Affiliations

¹ Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France.
² Department of Public Health, Biostatistic laboratory, Strasbourg University Hospital, Strasbourg, France.
³ INSERM Unit 1113, IRFAC, Strasbourg, France.

Abstract

Objectives: Current recommendations regarding enhanced recovery programs (ERPs) after complete cytoreductive surgery (CCRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are based on a low level of evidence. The aim of this study is to evaluate the effect of implementing an adapted ERP for CCRS and HIPEC in a referral center.

Methods: We conducted a study with a prospective group of 44 patients (post-ERP group) who underwent CCRS with HIPEC between July 2016 and June 2018, the period during which ERP was implemented. This group was compared to a second retrospective group of 21 patients who underwent CCRS with HIPEC between June 2015 and June 2016, during which ERP was not yet implemented (pre-ERP group).

Results: The ERP compliance rate was 65% in the post-ERP group. The hospital length of stay (HLS) was shorter in the post-ERP group: 24.9 days (IQR 11-68, pre-ERP group) vs. 16.1 days (IQR 6-45, post-ERP group), as was the major morbidity rate (pre-ERP group=33.3% vs. post-ERP group=20.5%). The nasogastric tube, urinary catheter and abdominal drains were all retrieved faster in the post-ERP group.

Conclusions: The implementation of an adapted ERP after CCRS with HIPEC procedures reduces morbidity and shortens the HLS.

Keywords: enhanced recovery after surgery (ERAS); enhanced recovery programs; hyperthermic intraperitoneal chemotherapy (HIPEC); peritoneal carcinomatosis.