术后强化康复对于细胞减灭术联合腹腔内热化疗是安全的。
Enhanced recovery after surgery is safe for cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.
机构信息
Department of Surgery, Division of Surgical Oncology, University of Louisville School of Medicine, USA.
Department of Surgery, Division of Surgical Oncology, University of Louisville School of Medicine, USA.
出版信息
Am J Surg. 2020 Dec;220(6):1428-1432. doi: 10.1016/j.amjsurg.2020.08.041. Epub 2020 Sep 4.
INTRODUCTION
Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is an effective, aggressive approach to treating intraperitoneal carcinomatosis. This study aimed to test the efficacy/safety of an enhanced recovery (ERAS) program after CRS-HIPEC surgery.
METHODS
Review of an IRB-approved prospectively maintained HIPEC database from 2003 to 2019. Adverse events and outcomes related to the primary operation were noted.
RESULTS
125 HIPEC procedures performed met inclusion criteria, with 20 treated through ERAS. There was an improvement in LOS (ERAS: 9, 6.0-28.0; non-ERAS: 11.0, 6.0-45.1, P = 0.5), a significant reduction in opioid use during hospitalization (ERAS Total Morphine Equivalents 156 vs Non-ERAS of 856, p < 0.001), and a significant reduction in discharge opioid requirements (ERAS 55% of patients, non-ERAS 97%, p < 0.02).
CONCLUSION
ERAS for CRS-HIPEC is safe, while maintaining quality outcomes, and leads to significant reductions in hospital opioid use and discharge narcotic usage. Our experience supports the full implementation of an ERAS protocol for HIPEC.
简介
细胞减灭术联合腹腔内热灌注化疗（CRS-HIPEC）是一种治疗腹腔转移癌的有效且激进的方法。本研究旨在检验细胞减灭术联合腹腔内热灌注化疗术后强化康复（ERAS）方案的疗效/安全性。
方法
回顾分析了 2003 年至 2019 年经机构审查委员会批准的前瞻性维持 HIPEC 数据库。记录与主要手术相关的不良事件和结局。
结果
125 例符合纳入标准的 HIPEC 手术中，有 20 例通过 ERAS 治疗。住院时间（ERAS：9，6.0-28.0；非 ERAS：11.0，6.0-45.1，P=0.5）、住院期间阿片类药物使用量（ERAS 总吗啡当量 156 与非 ERAS 的 856，p<0.001）和出院时阿片类药物需求（ERAS 55%的患者，非 ERAS 97%，p<0.02）均有显著改善。
结论
CRS-HIPEC 的 ERAS 是安全的，同时保持了高质量的结果，并显著减少了住院期间阿片类药物的使用和出院时麻醉性镇痛药的使用。我们的经验支持全面实施 HIPEC 的 ERAS 方案。
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