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Ioannidis O, Anestiadou E, Ramirez JM, Fabbri N, Ubieto JM, Feo CV, Pesce A, Rosetzka K, Arroyo A, Kocián P, Sánchez-Guillén L, Bellosta AP, Whitley A, Enguita AB, Teresa-Fernandéz M, Bitsianis S, Symeonidis S. The EUPEMEN (EUropean PErioperative MEdical Networking) Protocol for Acute Appendicitis: Recommendations for Perioperative Care. J Clin Med 2024; 13:6943. [PMID: 39598087 PMCID: PMC11594694 DOI: 10.3390/jcm13226943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Revised: 11/09/2024] [Accepted: 11/14/2024] [Indexed: 11/29/2024] Open
Abstract
Background/Objectives: Acute appendicitis (AA) is one of the most common causes of emergency department visits due to acute abdominal pain, with a lifetime risk of 7-8%. Managing AA presents significant challenges, particularly among vulnerable patient groups, due to its association with substantial morbidity and mortality. Methods: The EUPEMEN (European PErioperative MEdical Networking) project aims to optimize perioperative care for AA by developing multidisciplinary guidelines that integrate theoretical knowledge and clinical expertise from five European countries. This study presents the key elements of the EUPEMEN protocol, which focuses on reducing surgical stress, optimizing perioperative care, and enhancing postoperative recovery. Results: Through this standardized approach, the protocol aims to lower postoperative morbidity and mortality, shorten hospital stays, and improve overall patient outcomes. The recommendations are tailored to address the variability in clinical practice across Europe and are designed to be widely implementable in diverse healthcare settings. Conclusions: The conclusions drawn from this study highlight the potential for the EUPEMEN protocol to significantly improve perioperative care standards for AA, demonstrating its value as a practical, adaptable tool for clinicians.
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Affiliation(s)
- Orestis Ioannidis
- Fourth Department of Surgery, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital “George Papanikolaou”, 57010 Thessaloniki, Greece; (E.A.); (S.B.); (S.S.)
| | - Elissavet Anestiadou
- Fourth Department of Surgery, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital “George Papanikolaou”, 57010 Thessaloniki, Greece; (E.A.); (S.B.); (S.S.)
| | - Jose M. Ramirez
- Institute for Health Research Aragón, 50009 Zaragoza, Spain; (J.M.R.); (J.M.U.); (A.P.B.); (A.B.E.); (M.T.-F.)
- Department of Surgery, Faculty of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
| | - Nicolò Fabbri
- Department of Surgery, Azienda Unità Sanitaria Locale Ferrara—University of Ferrara, 44121 Ferrara, Italy; (N.F.); (C.V.F.); (A.P.)
| | - Javier Martínez Ubieto
- Institute for Health Research Aragón, 50009 Zaragoza, Spain; (J.M.R.); (J.M.U.); (A.P.B.); (A.B.E.); (M.T.-F.)
- Department of Anesthesia, Resuscitation and Pain Therapy, Miguel Servet University Hospital, 50009 Zaragoza, Spain
| | - Carlo Vittorio Feo
- Department of Surgery, Azienda Unità Sanitaria Locale Ferrara—University of Ferrara, 44121 Ferrara, Italy; (N.F.); (C.V.F.); (A.P.)
| | - Antonio Pesce
- Department of Surgery, Azienda Unità Sanitaria Locale Ferrara—University of Ferrara, 44121 Ferrara, Italy; (N.F.); (C.V.F.); (A.P.)
| | - Kristyna Rosetzka
- Department of Plastic Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, 150 06 Prague, Czech Republic;
| | - Antonio Arroyo
- Department of Surgery, Universidad Miguel Hernández Elche, Hospital General Universitario Elche, 03203 Elche, Spain; (A.A.); (L.S.-G.)
- Grupo Español de Rehabilitación Multimodal (GERM), 50009 Zaragoza, Spain
| | - Petr Kocián
- Department of Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, 150 06 Prague, Czech Republic;
| | - Luis Sánchez-Guillén
- Department of Surgery, Universidad Miguel Hernández Elche, Hospital General Universitario Elche, 03203 Elche, Spain; (A.A.); (L.S.-G.)
- Grupo Español de Rehabilitación Multimodal (GERM), 50009 Zaragoza, Spain
| | - Ana Pascual Bellosta
- Institute for Health Research Aragón, 50009 Zaragoza, Spain; (J.M.R.); (J.M.U.); (A.P.B.); (A.B.E.); (M.T.-F.)
- Department of Anesthesia, Resuscitation and Pain Therapy, Miguel Servet University Hospital, 50009 Zaragoza, Spain
- Grupo Español de Rehabilitación Multimodal (GERM), 50009 Zaragoza, Spain
| | - Adam Whitley
- Department of Surgery, University Hospital Kralovske Vinohrady, 100 34 Prague, Czech Republic;
| | - Alejandro Bona Enguita
- Institute for Health Research Aragón, 50009 Zaragoza, Spain; (J.M.R.); (J.M.U.); (A.P.B.); (A.B.E.); (M.T.-F.)
- Grupo Español de Rehabilitación Multimodal (GERM), 50009 Zaragoza, Spain
| | - Marta Teresa-Fernandéz
- Institute for Health Research Aragón, 50009 Zaragoza, Spain; (J.M.R.); (J.M.U.); (A.P.B.); (A.B.E.); (M.T.-F.)
| | - Stefanos Bitsianis
- Fourth Department of Surgery, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital “George Papanikolaou”, 57010 Thessaloniki, Greece; (E.A.); (S.B.); (S.S.)
| | - Savvas Symeonidis
- Fourth Department of Surgery, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital “George Papanikolaou”, 57010 Thessaloniki, Greece; (E.A.); (S.B.); (S.S.)
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Abstract
Surgery is a mainstay treatment for patients with solid tumours. However, despite surgical resection with a curative intent and numerous advances in the effectiveness of (neo)adjuvant therapies, metastatic disease remains common and carries a high risk of mortality. The biological perturbations that accompany the surgical stress response and the pharmacological effects of anaesthetic drugs, paradoxically, might also promote disease recurrence or the progression of metastatic disease. When cancer cells persist after surgery, either locally or at undiagnosed distant sites, neuroendocrine, immune, and metabolic pathways activated in response to surgery and/or anaesthesia might promote their survival and proliferation. A consequence of this effect is that minimal residual disease might then escape equilibrium and progress to metastatic disease. Herein, we discuss the most promising proposals for the refinement of perioperative care that might address these challenges. We outline the rationale and early evidence for the adaptation of anaesthetic techniques and the strategic use of anti-adrenergic, anti-inflammatory, and/or antithrombotic therapies. Many of these strategies are currently under evaluation in large-cohort trials and hold promise as affordable, readily available interventions that will improve the postoperative recurrence-free survival of patients with cancer.
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