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Perioperative care in primary retroperitoneal sarcoma surgery: A Hispano-Luso survey on current practices
Pablo Lozano Lominchar1, Paula Muñoz2, Cristina Ballester3
1Department of General Surgery and Surgical Oncology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.
Background:
Retroperitoneal sarcoma (RPS) is a rare malignancy requiring complex surgical management. While Enhanced Recovery After Surgery (ERAS) protocols have improved outcomes in various surgical specialties, their implementation in RPS remains inconsistent.
Objective:
This study aimed to evaluate current perioperative care practices for RPS surgery across Spain and Portugal, identifying gaps in protocol standardization and assessing the feasibility of consensus-based approaches.
Methods:
A structured online survey was distributed to members of the Spanish and Portuguese Societies of Surgeons. The questionnaire encompassed five domains: demographics, preoperative, intraoperative, and postoperative practices, and attitudes toward perioperative consensus.
Results:
Among 266 survey accesses, 37 complete responses were analyzed. Only 27% of respondents reported having a dedicated ERAS protocol for RPS, though 89.2% employed ERAS pathways for other surgeries. Prehabilitation elements - such as smoking cessation (21.6%), nutritional support (73%), and supervised physical therapy (37.8%) - were inconsistently applied. Intraoperatively, goal-directed fluid therapy was used by 51.4%, while 97.3% adhered to restrictive transfusion thresholds. Postoperative variability was notable in diet resumption, mobilization, and nasogastric tube use. All respondents supported the creation of an RPS-specific perioperative care consensus.
Conclusions:
There is marked heterogeneity in perioperative care for RPS across Iberian centers. Standardized, evidence-based guidelines are urgently needed to improve consistency and optimize patient outcomes.
