title: Current Delivery of Hyperthermic Intraperitoneal Chemotherapy with Cytoreductive Surgery (CS/HIPEC) and Perioperative Practices: An International Survey of High-Volume Surgeons.
abstract: BACKGROUND
  Cytoreductive surgery and heated intraperitoneal chemotherapy (CS/HIPEC) is performed for selected indications at a limited number of specialized centers worldwide. Currently there is no standardized approach to the perioperative care process. We sought to capture current practices in the perioperative management of patients who undergo CS/HIPEC at high-volume centers.
  
  
  METHODS
  Surgeon members of the American Society of Peritoneal Surface Malignancies working at high-volume CS/HIPEC centers (>10 cases/year) were invited to complete an online survey. The survey included questions relating to preoperative preparation of patients, intraoperative practices, and postoperative care.
  
  
  RESULTS
  Ninety-seven surgeons from five continents completed the survey (response rate 55%). The majority (80%) practiced in academic environments. Most respondents (68%) indicated that a formal preoperative preparatory pathway for CS/HIPEC surgery existed at their centers, but few (26%) had used enhanced recovery protocols in this group of patients. Whereas the intraoperative technical practices of the CS/HIPEC procedure were relatively consistent across respondents, there was little agreement on pre- and postoperative care practices, including use of mechanical bowel preparation, nutritional supplementation, methods of perioperative analgesia, timing of physical therapy and ambulation, nasogastric tube and Foley removal, intravenous fluids, blood transfusion parameters, and postoperative use of deep-vein thrombosis prophylaxis and antibiotics.
  
  
  CONCLUSIONS
  Perioperative care practices for CS/HIPEC are widely variable nationally and internationally. Standardization of such practices offers an opportunity to incorporate evidence-based interventions and may enhance patient outcomes and improve care standards across all centers that offer this procedure.
authors.affiliation: Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Allison H
authors.initials: AH
authors.lastname: Maciver
authors.affiliation: Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Eisar
authors.initials: E
authors.lastname: Al-Sukhni
authors.affiliation: Cancer Treatment Centers of America, Philadelphia, PA, USA.
authors.forename: Jesus
authors.initials: J
authors.lastname: Esquivel
authors.affiliation: Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Skitzki
authors.affiliation: Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Kane
authors.affiliation: Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA. Valerie.francescutti@roswellpark.org.
authors.forename: Valerie A
authors.initials: VA
authors.lastname: Francescutti
mesh_terms: D000328:Adult; D000368:Aged; D000698:Analgesia / Q000379:methods; D000758:Anesthesia / Q000379:methods; D019072:Antibiotic Prophylaxis; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001803:Blood Transfusion; D065426:Cytoreduction Surgical Procedures; D004434:Early Ambulation; D005440:Fluid Therapy; D061847:Hospitals, High-Volume; D006801:Humans; D006979:Hyperthermia, Induced; D007263:Infusions, Parenteral; D007430:Intraoperative Care / Q000379:methods; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D018529:Nutritional Support; D019990:Perioperative Care / Q000379:methods*; D010534:Peritoneal Neoplasms / Q000628:therapy*; D026741:Physical Therapy Modalities; D011182:Postoperative Care / Q000379:methods; D010818:Practice Patterns, Physicians'; D011300:Preoperative Care / Q000379:methods; D011795:Surveys and Questionnaires; D020246:Venous Thrombosis / Q000517:prevention & control