原発性後腹膜肉腫手術における周術期管理：現行の診療に関するイスパノ・ルソ調査

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.

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.

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.

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.

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.