ERAS® Guidelines Validation of CRS With or Without HIPEC

Study Overview
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Brief Summary
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Enhanced recovery after surgery (ERAS®) pathways have been shown to considerably reduce complications, length of stay and costs after most of surgical procedures by standardised application of best evidence-based perioperative care. Recently an international panel of expert have succeeded to elaborate dedicated recommendations for cytoreductive surgery (CRS) ± hyperthermic intraperitoneal chemotherapy (HIPEC) in a two-part series of guidelines based on expert consensus (Hübner et al., EJSO, 2020). The aim of this prospective validation study was therefore to study acceptance, feasibility and clinical results of these guidelines in clinical practice. Hypothesis of the study: Introduction of ERAS® guidelines is feasible and safe. Increasing compliance with ERAS® guidelines (after implementation) will improve recovery and early clinical outcomes of patients undergoing CRS/HIPEC.

Detailed Description
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The study includes two succesive phases interrupted by a stage to implement ERAS® guidelines.

Official Title
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Feasibility and Clinical Results of Implementation of ERAS® Guidelines for Cytoreductive Surgery With or Without Hyperthermic Intraperitoneal Chemotherapy: an International Prospective Cohort Study

Conditions
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Peritoneal Diseases

Intervention / Treatment
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* Other: Pre-ERAS® phase (current clinical practice)
* Other: Post-ERAS® implementation phase


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adults female and male patients (> 18 year-old) Peritoneal cancer from colorectal, ovarian, gastric, appendix origin and primitive peritoneal cancer (peritoneal mesothelioma) Multidisciplinary team meeting validation for CRS/HIPEC Informed and signed surgical consent Exclusion Criteria: Patients without peritoneal cancer Patients with peritoneal cancer and extended extraperitoneal metastases contraindicating for CRS with or without HIPEC No informed consent signed

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Pre-ERAS® implementation phase<br>Current clinical practice Current perioperative management All consecutive patients included for CRS+-HIPEC treatment Period of inclusion : 3 months (01.10.2021 - 31.12.2021) Survey of intended changes in clinical practice will be sent to each leader center No specific intervention. Only descriptive recordings of pre-intra-post-operative clinical endpoints (ERAS® core items) and demographic parameters. Clinical and surgical outcomes will be recorded until 30 postoperative days (POD). Functional recovery parameters will be recorded for the first 5 POD | Other: Pre-ERAS® phase (current clinical practice)<br>* Descriptive recordings of pre-intra-post-operative clinical endpoints and demographic parameters.<br>|
| Post-ERAS® implementation phase<br>After implementation 2 months of delay before starting the recordings Clinical practice and perioperative management with new practice according guidelines and local commitment for the new change All consecutive patients included for CRS±HIPEC treatment Period of inclusion : 3 months (01.03.2022 - 31.05.2022) Max 2 months of delay allowed between the two phases Intervention will take place during an implementation period of 2 months. This period will let the centers to set the newly implemented clinical practices. After that, the remaining 3 months of the study will consist in descriptive recordings of pre-intra and post-operative clinical endpoints and demographic parameters (ERAS® core items). Clinical and surgical outcomes will be recorded until 30 postoperative days (POD). Functional recovery parameters will be recorded for the first 5 POD. | Other: Post-ERAS® implementation phase<br>* Descriptive recordings of pre-intra-post-operative clinical endpoints and demographic parameters.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Compliance of ERAS® guidelines | Post-ERAS® implementation phase: compliance rate towards the relevant core items from ERAS guidelines | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Acceptance and feasibility of ERAS® guidelines | Pre-ERAS® phase (current clinical practice): current compliance rate towards the ERAS guidelines | 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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CRS, HIPEC, ERAS®, Guidelines, Peritoneal metastasis, Colorectal, Gastric, ovarian, Peritoneal mesothelioma, Pseudomyxoma peritonei