Cytoreductive surgery

Cytoreductive surgery (CRS), performed with or without hyperthermic intraperitoneal chemotherapy (HIPEC), represents one of the most complex and demanding procedures in surgical oncology. Used in the management of peritoneal surface malignancies, CRS±HIPEC is among the highest-risk abdominal operations offered to patients with advanced cancer, and decision-making around whether to proceed is often challenging for both patients and clinical teams.

ERAS pathways have been shown to considerably reduce complications, length of stay, and costs across a broad range of surgical procedures through the standardised application of best evidence-based perioperative care. Given the physiological demands of cytoreductive surgery — which may involve extensive abdominal resection, prolonged operative times, and the added systemic effects of intraperitoneal chemotherapy — there is a clear and compelling need for a structured, evidence-based perioperative approach tailored specifically to this patient group.

ERAS protocols have the potential to reduce length of stay and support return to full functional recovery after cytoreductive surgery and HIPEC, and real-world implementation has demonstrated this benefit. Following ERAS implementation in CRS/HIPEC programmes, compliance with perioperative care protocols and significant reductions in length of stay have been achieved without compromising patient safety.

The ERAS® Society guidelines for perioperative care in CRS±HIPEC have been published in two parts in the European Journal of Surgical Oncology, covering preoperative and intraoperative management in Part I, and postoperative care and special considerations in Part II. Developed by a multidisciplinary panel of 24 experts across general surgery, gynaecological surgery, and anaesthesia, the guidelines systematically reviewed evidence across 72 perioperative care items using the GRADE system. These recommendations provide clinicians with a robust, consensus-driven framework for delivering optimal care to this complex patient population.