Improta L, Ciniselli CM, Verderio P, Pasquali S, Fiore M, Valeri S. Surgeons’ opinions about enhanced recovery after surgery for retroperitoneal sarcoma: A survey. World J Clin Oncol 2025; 16(10): 108419 [DOI: 10.5306/wjco.v16.i10.108419]
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Oct 24, 2025 (publication date) through Oct 27, 2025
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Publication Name
World Journal of Clinical Oncology
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2218-4333
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Improta L, Ciniselli CM, Verderio P, Pasquali S, Fiore M, Valeri S. Surgeons’ opinions about enhanced recovery after surgery for retroperitoneal sarcoma: A survey. World J Clin Oncol 2025; 16(10): 108419 [DOI: 10.5306/wjco.v16.i10.108419]
Chiara Maura Ciniselli, Paolo Verderio, Bioinformatics and Biostatistics Unit, Department of Applied Research and Technological Developement, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Lombardy, Italy
Sandro Pasquali, Marco Fiore, Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Lombardy, Italy
Sandro Pasquali, Molecularar Pharmacology Unit, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Lombardy, Italy
Author contributions: Improta L, Ciniselli CM, Verderio P, Pasquali S, Fiore M, Valeri S, conceptualized and designed the study; Improta L collected data; Verderio P, Ciniselli CM, Pasquali S performed statistical analyses; Improta L, Pasquali S, Fiore M prepared the manuscript; Valeri S, Ciniselli CM, Verderio P reviewed the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Received: April 14, 2025 Revised: June 22, 2025 Accepted: September 29, 2025 Published online: October 24, 2025 Processing time: 193 Days and 18.6 Hours
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.
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.
