Pleura and Peritoneum最新文献

{"title":"Clinical utility of the peritoneal pathologic regression in gastric cancer patients associated to peritoneal metastasis. a study protocol.","authors":"Silvia Guerrero-Macías, María Eugenia Manrique-Acevedo, Carlos E Bonilla, Magda Vargas Diaz, Xavier Delgadillo","doi":"10.1515/pp-2025-0005","DOIUrl":"10.1515/pp-2025-0005","url":null,"abstract":"<p><strong>Objectives: </strong>Peritoneal regression grade score (PRGS) has emerged a scoring system designed to measure the extent of residual disease following systemic or intraperitoneal therapies in patients with carcinomatosis. Higher (3-4) PRG-Scores match with a mediocre treatment response and prognosis. Conversely, lower grades (1-2) response are linked to significantly longer overall and progression-free survival periods. This study explores the utility of PRGS in assessing prognosis and optimizing therapeutic strategies for patients with peritoneal metastasis secondary to gastric malignancy.</p><p><strong>Methods: </strong>This is a prospective cohort study, including patients with gastric cancer and peritoneal metastasis undergoing chemotherapy with intent for subsequent cytoreductive surgery. The primary endpoint of the study is to assess the pathological response of peritoneal involvement to primary chemotherapy according to the PRGS. Secondary objectives are to correlate PRGS with some clinical, pathological and molecular features (MMR, PDL1, CPS, HER2) as well as with other clinical and biochemical markers related to chemotherapy response.</p><p><strong>Results: </strong>This protocol summarizes the current scientific evidence regarding the effectiveness of the PRGS in assessing peritoneal response to targeted therapies. It further hypothesizes its potential utility in evaluating the effects of systemic therapies for gastric cancer with peritoneal metastases, while also defining inclusion and exclusion criteria and outlining a flowchart for its implementation.</p><p><strong>Conclusions: </strong>Our final endpoint is to expand PRGS applications to curative settings and identify factors such as tumor biology and chemotherapy regimens that may guide patient selection for adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) in gastric cancer with peritoneal metastasis.</p>","PeriodicalId":20231,"journal":{"name":"Pleura and Peritoneum","volume":"10 3","pages":"147-152"},"PeriodicalIF":2.4,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of peritoneal disease arising from mucinous vs. non-mucinous appendiceal neoplasms with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.","authors":"Rennie Xinrui Qin, Tilisi Puloka, Jia Hui Lim, Caro Staheli, Jesse Fischer, Simione Lolohea, Jasen Ly","doi":"10.1515/pp-2025-0007","DOIUrl":"10.1515/pp-2025-0007","url":null,"abstract":"<p><strong>Objectives: </strong>Non-mucinous appendiceal neoplasms (NMAN) are rare. The role of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in treating peritoneal dissemination from NMAN is poorly defined. We hypothesise that histology impacts survival and compared the disease characteristics and short- and long-term outcomes of mucinous and non-mucinous appendiceal neoplasms treated with CRS/HIPEC.</p><p><strong>Methods: </strong>We retrospectively reviewed a prospective database of 228 patients with peritoneal disease from appendiceal primaries proceeding to CRS/HIPEC from 01/01/2008 to 30/06/2022 at a tertiary referral centre in New Zealand.</p><p><strong>Results: </strong>There were 209 mucinous appendiceal neoplasms (MANs) and 19 NMANs. NMANs were more likely to metastasise to lymph nodes (p<0.001) and be treated with systemic chemotherapy (p<0.001) than MANs. Surgery for NMAN was more likely to involve small bowel resection (p<0.001) and less likely to achieve complete cytoreduction (p<0.001). Short-term outcomes were similar between MAN and NMAN. CRS/HIPEC for NMAN had a major complication rate of 15.3 % and no perioperative mortality. Extraperitoneal recurrence, including pleural and systemic recurrence, was more likely to occur in NMAN than all grades of MAN. The median overall survival was not reached in MAN and 16.0 months in NMAN. High PCI, ECOG, and tumour grade were associated with poor survival in NMAN.</p><p><strong>Conclusions: </strong>The prognosis following CRS/HIPEC for NMAN is poor. Patients with NMAN need to be judiciously selected for CRS/HIPEC.</p>","PeriodicalId":20231,"journal":{"name":"Pleura and Peritoneum","volume":"10 3","pages":"137-145"},"PeriodicalIF":2.4,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time till pleuropulmonary recurrence for mesothelioma and high grade appendiceal neoplasm after CRS/HIPEC.","authors":"Tiffany Guadalupe Williams, Shoma Barat, David Lawson Morris","doi":"10.1515/pp-2025-0010","DOIUrl":"10.1515/pp-2025-0010","url":null,"abstract":"<p><strong>Objectives: </strong>Cytoreductive surgery with heated intraperitoneal chemotherapy (CRS/HIPEC) requiring diaphragmatic stripping or resection may predispose to pleuropulmonary recurrence. This review was to assess the rates of pleuropulmonary recurrence after CRS/HIPEC for patients who had high-grade appendiceal neoplasm and meosthelioma.</p><p><strong>Methods: </strong>A retrospective review (September 1996-November 2021) at a single tertiary center identified 716 patients who underwent CRS/HIPEC with diaphragmatic intervention; 203 had high-grade appendiceal neoplasms and 63 had mesothelioma. Radiologic or pathologic evidence of pleuropulmonary recurrence was recorded. Time from CRS/HIPEC to chest recurrence was analyzed using Kaplan-Meier methods.</p><p><strong>Results: </strong>Twenty patients (12 appendiceal; 8 mesothelioma) developed pleuropulmonary recurrence. In the appendiceal cohort (mean age 51.5 years; median PCI 30), all 12 underwent bilateral diaphragm intervention (four with full-thickness resection) with CCR 0-1. Time to chest recurrence ranged from 0.3 to 82.8 months; half experienced early respiratory complications (e.g., pleural effusion, pneumothorax). In the mesothelioma cohort (mean age 44.9 years; median PCI 22.1), seven had bilateral stripping (two with resection) and one had unilateral stripping; CCR was 0-1. Recurrence occurred between 8.0 and 85.4 months (median ∼31.4 months); half had early respiratory compromise. No significant associations were observed between PCI, CCR, or extent of diaphragmatic intervention and recurrence risk, although ICU stay and CCR weakly correlated with recurrence in mesothelioma.</p><p><strong>Conclusions: </strong>Pleuropulmonary recurrence following CRS/HIPEC with diaphragm intervention is rare (2.7 %), with early recurrences suggesting occult thoracic involvement. Bilateral diaphragm manipulation was common among those with recurrence.</p>","PeriodicalId":20231,"journal":{"name":"Pleura and Peritoneum","volume":"10 3","pages":"129-135"},"PeriodicalIF":2.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world data on Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC)-directed therapy in patients with peritoneal metastases; Third annual report from the ISSPP PIPAC database.","authors":"Magnus Skov Jørgensen, Pernille Schjødt Hansen, Claus W Fristrup, Martin Hübner, Jimmy So, Anne-Cecile Ezanno, Peter Hewett, Miguel Ruiz-Marin, Günther A Rezniczek, Özgül Düzgün, Marc Pocard, Francesco Casella, Laura Lay, Marisa Aral, Tarkan Jäger, Felix Laminger, Oliver Glehen, Claire-Angéline Goutard, Laurent Villeneuve, Andrea Di Giorgio, Michael Bau Mortensen","doi":"10.1515/pp-2025-0013","DOIUrl":"10.1515/pp-2025-0013","url":null,"abstract":"<p><strong>Objectives: </strong>In 2020, the International Society for the Study of the Pleura and Peritoneum (ISSPP) launched a database monitoring real-world data on Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC)-directed therapy in patients with peritoneal metastases (PM). This study covers data from the third annual report on the ISSPP PIPAC database.</p><p><strong>Methods: </strong>Systematic analysis of all data reported to the ISSPP PIPAC database between June 15th, 2020, and November 1st, 2024. We hypothesize that ISSPP PIPAC data align with existing literature.</p><p><strong>Results: </strong>Seventeen PIPAC centers reported 3224 PIPAC treatments in 1126 patients with PM (median number of treatments 2, range 1-33). The median peritoneal cancer index (PCI) at PIPAC 1 was 19 and remained unchanged during subsequent treatments. The number of patients with >500 mL ascites significantly decreased from the first three PIPAC treatments to PIPAC 4+ (p<0.01). Major complications (Dindo-Clavien ≥3b) occurred in 0.7 % of the treatments, while Common. Terminology Criteria for Adverse Events (CTCAE) grades ≥3 were reported in 5.2 %. Peritoneal regression grading score (PRGS) was performed in 2306 (72 %) of the treatments. At PIPAC 1, 2, and 3, complete or major response (mean PRGS ≤2) was achieved in 57 %, 72 %, and 75 % of the patients, respectively. Median overall survival from PIPAC 1 was 12.5 months. Patients with complete/major response (mean PRGS ≤2) at PIPAC 1-3 had a longer overall survival compared to patients with minimal/no response (mean PRGS >2).</p><p><strong>Conclusions: </strong>This study from the ISSPP PIPAC database provides substantial real-world data demonstrating the feasibility, safety, and potential effect of PIPAC-directed therapy in patients with PM.</p>","PeriodicalId":20231,"journal":{"name":"Pleura and Peritoneum","volume":"10 3","pages":"119-128"},"PeriodicalIF":2.4,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term survival in peritoneal mesothelioma treated with 24 consecutive PIPACs.","authors":"Matthias Mehdorn, Boris Jansen-Winkeln, Philipp Rhode, Stefan Niebisch, Yusef Moulla, Till Schönherr, Patrick Sven Plum, Florian Lordick, Rene Thieme, Gertraud Stocker, Maximilian von Laffert, Ines Gockel, Sigmar Stelzner","doi":"10.1515/pp-2024-0034","DOIUrl":"10.1515/pp-2024-0034","url":null,"abstract":"<p><strong>Objectives: </strong>Malignant peritoneal mesothelioma (MPM) is a rare disease with unspecific abdominal symptoms which is therefore often diagnosed at an advanced stage. Curative therapy is delivered by radical surgery, whereas palliative therapy consists of systemic chemotherapy. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a laparoscopically applied chemotherapy which was invented to administer high doses of chemotherapy intraperitoneally in palliative cases of peritoneal malignancies.</p><p><strong>Methods: </strong>The case of a male patient who received PIPAC treatment as individualized approach for unresectable malignant peritoneal mesothelioma is reported.</p><p><strong>Results: </strong>The patient began treatment with PIPAC procedures in 2017 for MPM that was unresectable because of extensive disease on the small bowel and refused systemic chemotherapy as the usual standard of care. We initiated PIPAC with doxorubicin and cisplatin and could reach stable disease within one year of treatment so that the therapy was discontinued for 2.5 years. Due to progressive disease, PIPAC was continued resulting in stable disease for 2 years. In total, the patient received 24 PIPAC procedures with no major surgical or toxic side effects over seven years timespan.</p><p><strong>Conclusions: </strong>We report the case of a patient with MPM who could reach long-term survival of seven years due to a total of 24 PIPAC procedures.</p>","PeriodicalId":20231,"journal":{"name":"Pleura and Peritoneum","volume":"10 3","pages":"111-117"},"PeriodicalIF":2.4,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The microbiome of pseudomyxoma peritonei: a scoping review.","authors":"D Sara Portela, Anshini Jain, Michael Flood, Aonghus Lavelle, Glen Guerra, Meera Patel, Omer Aziz, Satish Warrier, Alexander Heriot, Helen Mohan","doi":"10.1515/pp-2024-0016","DOIUrl":"10.1515/pp-2024-0016","url":null,"abstract":"<p><p>There is growing interest in the role of the microbiome in carcinogenesis, but few studies examine the microbiome of pseudomyxoma peritonei (PMP). This scoping review summarises the microorganisms identified in PMP samples and examines the evidence of their role in disease outcomes. The methodology was developed in accordance with the PRISMA-ScR framework and checklist. Nine relevant studies were included. Microbiological testing was performed on PMP samples from 85 patients. At the phylum level, Proteobacteria was detected in greatest relative abundance in tumour tissue, cellular and acellular mucin. The relative proportion of different phyla more closely resembled the gut microbiome in inflammatory bowel disease than in a healthy gut. High-grade specimens showed significantly higher bacterial density than low-grade specimens and non-neoplastic non-perforated appendix specimens. Survival data of 58 patients were published, correlating outcomes to pre-operative antibiotic administration. Observed differences were not statistically significant. There is evidence of an altered bacterial profile in PMP samples compared to a healthy gut microbiome, the significance of which is unclear. Significant methodological challenges remain in this field of study. This scoping review supports the need for further analysis of the PMP bacterial profile, using methodologies that incorporate controls and deliver taxonomic resolution at species level.</p>","PeriodicalId":20231,"journal":{"name":"Pleura and Peritoneum","volume":"10 2","pages":"35-50"},"PeriodicalIF":1.4,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144542011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for children and young adults: experience from two high volume centers.","authors":"Maximilian Eckert, Michael Gerken, Jens M Werner, Sebastian Blaj, Ferdinand Füsi, Niklas Bogovic, Hans J Schlitt, Matthias Hornung, Pompiliu Piso, Miklos Acs","doi":"10.1515/pp-2025-0011","DOIUrl":"10.1515/pp-2025-0011","url":null,"abstract":"<p><strong>Objectives: </strong>peritoneal surface malignancy in children is rare with a dismal prognosis. This bicentric study evaluated CRS with HIPEC in patients aged 2-25 years.</p><p><strong>Methods: </strong>Clinicopathological and treatment-related factors were retrospectively analyzed from 21 patients undergoing CRS and HIPEC between 2009 and 2022. Endpoints were feasibility, chemotherapeutic compound, complications, and overall survival (OS).</p><p><strong>Results: </strong>The mean age was 20.4 years. The mean peritoneal cancer index (PCI) was 12.8. Mean follow-up period was 6.8 years. Median overall survival time was 2.4. 5-year survival rate was 42.9 %. 76.2 % had primary and 23.8 % recurrent disease. The most common primary tumor locations were colon (33.3 %) and appendix (14.3 %). Adenocarcinoma was the most common histological subtype (71.4 %). Univariable Cox regression analysis showed significant impaired OS after previous chemotherapy (p=0.46) and incomplete cytoreduction CCR-2 (p=0.43). No perioperative mortalities occurred. The incidence of major complications was 24 %.</p><p><strong>Conclusions: </strong>Multimodal treatment can be considered in pediatric patients with peritoneal carcinomatosis. It presents a safe and feasible therapy with manageable complications and no perioperative mortality when performed by an experienced multidisciplinary team. Indication for CRS and HIPEC in children should be an individual decision by an interdisciplinary tumor board in the absence of better alternatives.</p>","PeriodicalId":20231,"journal":{"name":"Pleura and Peritoneum","volume":"10 3","pages":"99-109"},"PeriodicalIF":2.4,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing patient recovery: prospective study evaluating compliance and clinical outcomes of enhanced recovery protocols in ovarian cancer following cytoreductive surgery with HIPEC.","authors":"S P Somashekhar, Kumar C Rohit, Aaron Fernandes, Vijay Ahuja, Kushal Aggarwal, Esha Shanbhag, K R Ashwin","doi":"10.1515/pp-2024-0017","DOIUrl":"10.1515/pp-2024-0017","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the implementation, compliance, and impact of the enhanced recovery after surgery (ERAS) protocol on perioperative outcomes in patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for Stage IIIc ovarian cancer.</p><p><strong>Methods: </strong>From September 2020 to March 2022, the ERAS protocol (62 perioperative and special consideration guidelines) was prospectively implemented in 75 patients. Based on compliance rates, patients were divided into three groups: Group A (<70 %, 13 patients), Group B (70 %-80 %, 52 patients), and Group C (>80 %, 10 patients). Compliance rates, length of stay, postoperative complications, and readmission rates were analyzed. Ethical committee approval was obtained.</p><p><strong>Results: </strong>The cohort's average compliance was 74.5 %, with group averages of 68.4 %, 74.4 %, and 82.5 % (p<0.001). Tolerance to normal diet (p=0.008), postoperative ileus (p=0.161), and mobilization rates (p<0.001) improved with higher compliance. Higher compliance also led to shorter hospital stays (p=0.008) and ICU stays (p<0.001). Complications like ileus and infections were lowest in Group C. No significant differences were found in re-surgery or mortality.</p><p><strong>Conclusions: </strong>Implementation of the ERAS protocol in patients undergoing CRS and HIPEC for Stage IIIc ovarian cancer is feasible and associated with improved postoperative outcomes. Higher compliance with ERAS guidelines significantly reduced length of hospital and ICU stay, enhanced early mobilization, and improved tolerance to diet, while also decreasing postoperative complications. Compliance above 80 % is necessary for achieving optimal outcomes and protocol modifications may improve compliance.</p>","PeriodicalId":20231,"journal":{"name":"Pleura and Peritoneum","volume":"10 2","pages":"89-98"},"PeriodicalIF":1.4,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144542009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of surgical staging in patients with colorectal peritoneal metastases scheduled for CRS-HIPEC.","authors":"Lana Ghanipour, Johan Wallin, Peter Cashin, Wilhelm Graf","doi":"10.1515/pp-2024-0013","DOIUrl":"10.1515/pp-2024-0013","url":null,"abstract":"<p><strong>Objectives: </strong>Surgical staging procedures are used to select patients with peritoneal metastases for surgery. We aimed to evaluate the impact of surgical staging procedures and the risk of abdominal wall recurrences in patients with peritoneal metastases scheduled for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC).</p><p><strong>Methods: </strong>Data were collected from a prospective maintained HIPEC register January 2012-December 2019. Patients with colorectal peritoneal metastases were included. Information about surgical staging procedures was registered. Results were then compared with those registered at definite CRS-HIPEC surgery and survival was analysed in relation to surgical staging procedures.</p><p><strong>Results: </strong>In total, 138 patients were included, of whom 32 had undergone a surgical staging procedure before CRS-HIPEC. Median overall survival in the surgical staging group was 1.89 years and in the non-staging group 3.07 years (p=0.060). In the surgical staging group, eight patients developed abdominal wall recurrences (25 %) compared with three (3 %) in the non-staged group. Eight staged patients (25 %) were considered inoperable at definite surgery (open-close). PCI score (p<0.001) was higher at definite surgery in patients who had undergone a staging laparoscopy. Factors associated with shorter overall survival in multivariate analysis were: open and close, PCI ≥21 and presence of signet ring cells. However, a staging procedure was not associated with a shorter overall survival.</p><p><strong>Conclusions: </strong>Surgical staging procedures is a valuable assessment of inoperability, though at the expense of more frequent abdominal wall recurrences. Imaging-based strategies may provide useful insights into whether surgical staging is the most effective approach for patient selection.</p>","PeriodicalId":20231,"journal":{"name":"Pleura and Peritoneum","volume":"10 2","pages":"59-68"},"PeriodicalIF":1.4,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144542010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of an enhanced recovery after surgery (ERAS) program in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: study protocol for a prospective multicenter interventional trial (EPICH study).","authors":"Manuela Robella, Eva Pagano, Lisa Giacometti, Armando Cinquegrana, Luca Pellegrino, Andrea Evangelista, Alessandra Saliva, Alessandro Cerutti, Felice Borghi","doi":"10.1515/pp-2024-0033","DOIUrl":"10.1515/pp-2024-0033","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to evaluate the clinical impact of introducing an Enhanced Recovery After Surgery (ERAS) protocol in the management of patients undergoing cytoreductive surgery (CRS), with or without hyperthermic intraperitoneal chemotherapy (HIPEC). By addressing a population at high risk of postoperative complications and delayed recovery, the study seeks to determine whether ERAS can improve short-term outcomes, optimize perioperative care, and promote faster and safer recovery in a standardized, evidence-based manner across multiple centers.</p><p><strong>Methods: </strong>The EPICH study is a multicenter, prospective, interventional trial conducted across 20 centers in Italy. A total of 300 patients undergoing CRS±HIPEC will be enrolled in two sequential phases: standard perioperative care followed by ERAS protocol implementation. The primary endpoint is the mean hospital length of stay (LOS). Secondary endpoints include postoperative complications, ICU admission, readmission rates, bowel function recovery, mortality, and patient-reported quality of recovery. The ERAS protocol includes prehabilitation, anemia and nutritional optimization, intraoperative fluid and pain management, and early mobilization and oral feeding. Data will be analyzed using random-effects linear models to account for center-level variation and confounding factors.</p><p><strong>Results: </strong>Preliminary evidence suggests that the ERAS protocol may help reduce mean hospital LOS, postoperative complications, and ICU stays, as well as support faster bowel recovery and improved patient-reported outcomes-findings that this study seeks to validate.</p><p><strong>Conclusions: </strong>The EPICH study could provide robust evidence supporting the adoption of ERAS as the standard of care for patients undergoing CRS±HIPEC, with potential benefits in terms of improved recovery, reduced complications, and decreased healthcare resource utilization.</p>","PeriodicalId":20231,"journal":{"name":"Pleura and Peritoneum","volume":"10 2","pages":"51-58"},"PeriodicalIF":1.4,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144542008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}