Surgeons’ opinions about enhanced recovery after surgery for retroperitoneal sarcoma: A survey

Abstract

BACKGROUND

Enhanced recovery after surgery (ERAS) programs provide recommendations for an optimized management of patients undergoing surgery. An ERAS program tailored on surgery for retroperitoneal sarcomas (RPS) may improve patient outcomes and it has still not been established.

AIM

To determine how an ERAS program tailored to RPS surgery can be agreed upon, structured, and implemented.

METHODS

Twenty-five candidate items from existing ERAS programs, potentially relevant for RPS surgery, were identified via literature review and expert input. These were included in a questionnaire refined through cognitive interviews and pilot testing. Expert sarcoma surgeons rated each item’s relevance and feasibility on a 6-point scale. The survey was recirculated after one year. Intra-observer reproducibility, inter-observer concordance, and agreement with the modal value of the most experienced participants were analyzed.

RESULTS

Thirteen sarcoma surgeons from 6 centers participated in the survey. Although surgeons agreed on several items, their overall concordance was low. After recirculating the survey, the intra-observer reproducibility was low. Interestingly, the median concordance with the reference increased for relevance and decreased for feasibility.

CONCLUSION

Despite interest in ERAS for RPS, surgeon concordance on item relevance and feasibility remains low, underscoring the need for collaborative efforts toward a standardized, consensus-based protocol.

Keywords: Retroperitoneal sarcoma; Enhanced recovery after surgery; Fast-track surgery; Sarcoma surgery; Perioperative care; Surgical outcomes

Core Tip: This study explores the development of an enhanced recovery after surgery (ERAS) program tailored to retroperitoneal sarcoma (RPS) surgery through a structured expert survey. Despite growing interest, surgeon concordance on the relevance and feasibility of proposed ERAS items remains limited, even after a one-year interval. These findings underscore the complexity of translating general ERAS principles into RPS-specific protocols and highlight the urgent need for broader multidisciplinary collaboration to establish a standardized, consensus-based pathway. This work lays the groundwork for future efforts aimed at optimizing perioperative care and improving outcomes in RPS patients.