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NEW ENHANCED RECOVERY PATHWAY AFTER HIPEC IMPROVES OUTCOMES

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2019/09/04
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  NEW ENHANCED RECOVERY PATHWAY AFTER HIPEC IMPROVES OUTCOMES
 
  A treatment option that has shown to improve clinical outcomes and prognosis in patients with peritoneal metastasis is cytoreductive surgery with hyperthermic intraperitoneal chemotherapy ( HIPEC ) . While HIPEC can improve disease-free survival in many patients , it ’ s a major operation . 
 
  Referred to as the “ mother all surgeries ” by some surgeons,the marathon cytoreductive surgery with HIPEC carries risks , involves many abdominal resections , and can sometimes last 16 hours . Complications are not uncommon , and patients usually recover in the hospital for many days . 
 
  “ We wanted to improve the quality of life for patients with peritoneal disease , so we pioneered a new enhanced recovery pathway for patients who undergone HIPEC at the Brigham , ” said Nelya Melnitchouk , MD , MSc , Director of the Program in Peritoneal Surface Malignancy within the Division of Gastrointestinal Surgery . 
 
  Dr . Melnitchouk has spent the last several years refining an Enhanced Recovery After Surgery ( ERAS ) in collaboration with Matthias F . Stopfkuchen-Evans , MD , a general and GI anesthesiologist , and pioneer in ERAS . As the two added steps to their evolving protocol , they observed lower risks of complications after HIPEC and improved quality of life in patients who underwent the operation . 
 
  “ Following our protocol , we feed patients the day after their surgery , as opposed to placing nasogastric tube and waiting for flatus . We also emphasize preoperative carbohydrate loading to avoid starvation and stress response during the surgery , ” said Dr . Melnitchouk . 
 
  The ERAS protocol also limits the amount of intravenous fluids given to patients ( via “ goal-directed fluid therapy ” ) following HIPEC . Importantly , this step did not increase the risk of kidney injury and decreased ileus ( lack of movement in the intestines ) . 
 
  In fact , patients who were both fed a day after surgery and had their fluids limited after surgery regained their bowel functions faster , experienced fewer complications ( e . g . , less risk of anastomotic leak ) , and stayed in the hospital fewer days than patients who were not . 
 
  Dr . Melnitchouk will present clinical outcomes associated with this Enhanced Recovery After Surgery protocol at the 2019 ERAS USA Conference.An abstract has also been accepted for a meeting of the Society of Surgical Oncology . 
 
  “ Peritoneal disease is often heterogeneous with no standard algorithms for care , so we manage and treat patients individually . Since each patients ’ disease and risk tolerance is unique , we emphasize shared decision-making and carefully counsel each patient , ” said Melnitchouk . 
 
  All patients in the Peritoneal Malignancy Program are reviewed by a multidisciplinary tumor board where Dr . Melnitchouk receives input from medical oncology , radiation oncology and radiology . An expert gastrointestinal pathologist also confirms each patients ’ histology . 
 
  “ Our unique enhanced recovery pathway improves quality of life for many of our patients , but it also gives many patients with peritoneal metastasis the gift of time . A large percentage of these patients have been off systemic chemotherapy for a significant period and some are several years out with no evidence of cancer , ” said Dr . Melnitchouk . 
 
  新闻来源网站 : https : // brighamhealthvitallines . org / 2019 / 01 / 22 / new-enhanced-recovery-pathway-after-hipec-improves-outcomes /