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Background: The multidisciplinary perioperative and anaesthetic management of patients undergoing pelvic exenteration is
essential for good surgical outcomes. No clear guidelines have been established, and there is wide variation in clinical practice internationally.
This consensus statement consolidates clinical experience and best practice collectively, and systematically addresses
key domains in the perioperative and anaesthetic management.
Methods: The modified Delphi methodology was used to achieve consensus from the PelvEx Collaborative. The process included
one round of online questionnaire involving controlled feedback and structured participant response, two rounds of editing, and
one round of web-based voting. It was held from December 2019 to February 2020. Consensus was defined as more than 80 per cent
agreement, whereas less than 80 per cent agreement indicated low consensus.
Results: The final consensus document contained 47 voted statements, across six key domains of perioperative and anaesthetic
management in pelvic exenteration, comprising preoperative assessment and preparation, anaesthetic considerations, perioperative
management, anticipating possible massive haemorrhage, stress response and postoperative critical care, and pain management.
Consensus recommendations were developed, based on consensus agreement achieved on 34 statements.
Conclusion: The perioperative and anaesthetic management of patients undergoing pelvic exenteration is best accomplished by
a dedicated multidisciplinary team with relevant domain expertise in the setting of a specialized tertiary unit. This consensus
statement has addressed key domains within the framework of current perioperative and anaesthetic management among patients
undergoing pelvic exenteration, with an international perspective, to guide clinical practice, and has outlined areas for future clinical
research.
Perioperative management and anaesthetic considerations in pelvic exenterations using Delphi methodology: results from the PelvEx Collaborative / Chok, A Y; Oliver, A; Rasheed, S; Tan, E J; Kelly, M E; Aalbers, A G J; Abdul Aziz, N; Abecasis, N; Abraham-Nordling, M; Akiyoshi, T; Alberda, W; Albert, M; Andric, M; Angenete, E; Antoniou, A; Auer, R; Austin, K K; Aziz, O; Baker, R P; Bali, M; Baseckas, G; Bebington, B; Bedford, M; Bednarski, B K; Beets, G L; Berg, P L; Beynon, J; Biondo, S; Boyle, K; Bordeianou, L; Bremers, A B; Brunner, M; Buchwald, P; Bui, A; Burgess, A; Burger, J W A; Burling, D; Burns, E; Campain, N; Carvalhal, S; Castro, L; Caycedo-Marulanda, A; Chan, K K L; Chang, G J; Chew, M H; Chong, P; Christensen, H K; Clouston, H; Codd, M; Collins, D; Colquhoun, A J; Corr, A; Coscia, M; Coyne, P E; Creavin, B; Croner, R S; Damjanovic, L; Daniels, I R; Davies, M; Davies, R J; Delaney, C P; de Wilt, J H W; Denost, Q; Deutsch, C; Dietz, D; Domingo, S; Dozois, E J; Duff, M; Eglinton, T; Enrique-Navascues, J M; Espin-Basany, E; Evans, M D; Fearnhead, N S; Flatmark, K; Fleming, F; Frizelle, F A; Gallego, M A; Garcia-Granero, E; Garcia-Sabrido, J L; Gentilini, L; George, M L; George, V; Ghouti, L; Giner, F; Ginther, N; Glynn, R; Golda, T; Griffiths, B; Harris, D A; Hagemans, J A W; Hanchanale, V; Harji, D P; Helewa, R M; Hellawell, G; Heriot, A G; Hochman, D; Hohenberger, W; Holm, T; Holmström, A; Hompes, R; Jenkins, J T; Kaffenberger, S; Kandaswamy, G V; Kapur, S; Kanemitsu, Y; Kelley, S R; Keller, D S; Khan, M S; Kim, H; Kim, H J; Koh, C E; Kok, N F M; Kokelaar, R; Kontovounisios, C; Kristensen, H Ø; Kroon, H M; Kusters, M; Lago, V; Larsen, S G; Larson, D W; Law, W L; Laurberg, S; Lee, P J; Limbert, M; Lydrup, M L; Lyons, A; Lynch, A C; Mantyh, C; Mathis, K L; Margues, C F S; Martling, A; Meijerink, W J H J; Merkel, S; Mehta, A M; McArthur, D R; McDermott, F D; McGrath, J S; Malde, S; Mirnezami, A; Monson, J R T; Morton, J R; Mullaney, T G; Negoi, I; Neto, J W M; Nguyen, B; Nielsen, M B; Nieuwenhuijzen, G A P; Nilsson, P J; O’Dwyer, S T; Palmer, G; Pappou, E; Park, J; Patsouras, D; Pellino, G; Peterson, A C; Poggioli, G; Proud, D; Quinn, M; Quyn, A; Radwan, R W; Rasmussen, P C; Rausa, E; Regenbogen, S E; Renehan, A; Rocha, R; Rochester, M; Rohila, J; Rothbarth, J; Rottoli, M; Roxburgh, C; Rutten, H J T; Ryan, É J; Safar, B; Sagar, P M; Sahai, A; Saklani, A; Sammour, T; Sayyed, R; Schizas, A M P; Schwarzkopf, E; Scripcariu, V; Selvasekar, C; Shaikh, I; Shida, D; Simpson, A; Smart, N J; Smart, P; Smith, J J; Solbakken, A M; Solomon, M J; Sørensen, M M; Steele, S R; Steffens, D; Stitzenberg, K; Stocchi, L; Stylianides, N A; Swartling, T; Sumrien, H; Sutton, P A; Swartking, T; Taylor, C; Teras, J; Thurairaja, R; Toh, E L; Tsarkov, P; Tsukada, Y; Tsukamoto, S; Tuech, J J; Turner, W H; Tuynman, J B; Ramshorst, G H van; Zoggel, D van; Vasquez-Jimenez, W; Verhoef, C; Vizzielli, G; Voogt, E L K; Uehara, K; Wakeman, C; Warrier, S; Wasmuth, H H; Weber, K; Weiser, M R; Wheeler, J M D; Wild, J; Wilson, M; Wolthuis, A; Yano, H; Yip, B; Yip, J; Yoo, R N; Winter, D C; Tekkis, P P. - In: BJS OPEN. - ISSN 2474-9842. - ELETTRONICO. - 5:1(2021), pp. zraa055.1-zraa055.10. [10.1093/bjsopen/zraa055]
Perioperative management and anaesthetic considerations in pelvic exenterations using Delphi methodology: results from the PelvEx Collaborative
Chok, A Y;Oliver, A;Rasheed, S;Tan, E J;Kelly, M E;Aalbers, A G J;Abdul Aziz, N;Abecasis, N;Abraham-Nordling, M;Akiyoshi, T;Alberda, W;Albert, M;Andric, M;Angenete, E;Antoniou, A;Auer, R;Austin, K K;Aziz, O;Baker, R P;Bali, M;Baseckas, G;Bebington, B;Bedford, M;Bednarski, B K;Beets, G L;Berg, P L;Beynon, J;Biondo, S;Boyle, K;Bordeianou, L;Bremers, A B;Brunner, M;Buchwald, P;Bui, A;Burgess, A;Burger, J W A;Burling, D;Burns, E;Campain, N;Carvalhal, S;Castro, L;Caycedo-Marulanda, A;Chan, K K L;Chang, G J;Chew, M H;Chong, P;Christensen, H K;Clouston, H;Codd, M;Collins, D;Colquhoun, A J;Corr, A;Coscia, M;Coyne, P E;Creavin, B;Croner, R S;Damjanovic, L;Daniels, I R;Davies, M;Davies, R J;Delaney, C P;de Wilt, J H W;Denost, Q;Deutsch, C;Dietz, D;Domingo, S;Dozois, E J;Duff, M;Eglinton, T;Enrique-Navascues, J M;Espin-Basany, E;Evans, M D;Fearnhead, N S;Flatmark, K;Fleming, F;Frizelle, F A;Gallego, M A;Garcia-Granero, E;Garcia-Sabrido, J L;Gentilini, L;George, M L;George, V;Ghouti, L;Giner, F;Ginther, N;Glynn, R;Golda, T;Griffiths, B;Harris, D A;Hagemans, J A W;Hanchanale, V;Harji, D P;Helewa, R M;Hellawell, G;Heriot, A G;Hochman, D;Hohenberger, W;Holm, T;Holmström, A;Hompes, R;Jenkins, J T;Kaffenberger, S;Kandaswamy, G V;Kapur, S;Kanemitsu, Y;Kelley, S R;Keller, D S;Khan, M S;Kim, H;Kim, H J;Koh, C E;Kok, N F M;Kokelaar, R;Kontovounisios, C;Kristensen, H Ø;Kroon, H M;Kusters, M;Lago, V;Larsen, S G;Larson, D W;Law, W L;Laurberg, S;Lee, P J;Limbert, M;Lydrup, M L;Lyons, A;Lynch, A C;Mantyh, C;Mathis, K L;Margues, C F S;Martling, A;Meijerink, W J H J;Merkel, S;Mehta, A M;McArthur, D R;McDermott, F D;McGrath, J S;Malde, S;Mirnezami, A;Monson, J R T;Morton, J R;Mullaney, T G;Negoi, I;Neto, J W M;Nguyen, B;Nielsen, M B;Nieuwenhuijzen, G A P;Nilsson, P J;O’Dwyer, S T;Palmer, G;Pappou, E;Park, J;Patsouras, D;Pellino, G;Peterson, A C;Poggioli, G;Proud, D;Quinn, M;Quyn, A;Radwan, R W;Rasmussen, P C;Rausa, E;Regenbogen, S E;Renehan, A;Rocha, R;Rochester, M;Rohila, J;Rothbarth, J;Rottoli, M;Roxburgh, C;Rutten, H J T;Ryan, É J;Safar, B;Sagar, P M;Sahai, A;Saklani, A;Sammour, T;Sayyed, R;Schizas, A M P;Schwarzkopf, E;Scripcariu, V;Selvasekar, C;Shaikh, I;Shida, D;Simpson, A;Smart, N J;Smart, P;Smith, J J;Solbakken, A M;Solomon, M J;Sørensen, M M;Steele, S R;Steffens, D;Stitzenberg, K;Stocchi, L;Stylianides, N A;Swartling, T;Sumrien, H;Sutton, P A;Swartking, T;Taylor, C;Teras, J;Thurairaja, R;Toh, E L;Tsarkov, P;Tsukada, Y;Tsukamoto, S;Tuech, J J;Turner, W H;Tuynman, J B;Ramshorst, G H van;Zoggel, D van;Vasquez-Jimenez, W;Verhoef, C;Vizzielli, G;Voogt, E L K;Uehara, K;Wakeman, C;Warrier, S;Wasmuth, H H;Weber, K;Weiser, M R;Wheeler, J M D;Wild, J;Wilson, M;Wolthuis, A;Yano, H;Yip, B;Yip, J;Yoo, R N;Winter, D C;Tekkis, P P
2021
Abstract
Background: The multidisciplinary perioperative and anaesthetic management of patients undergoing pelvic exenteration is
essential for good surgical outcomes. No clear guidelines have been established, and there is wide variation in clinical practice internationally.
This consensus statement consolidates clinical experience and best practice collectively, and systematically addresses
key domains in the perioperative and anaesthetic management.
Methods: The modified Delphi methodology was used to achieve consensus from the PelvEx Collaborative. The process included
one round of online questionnaire involving controlled feedback and structured participant response, two rounds of editing, and
one round of web-based voting. It was held from December 2019 to February 2020. Consensus was defined as more than 80 per cent
agreement, whereas less than 80 per cent agreement indicated low consensus.
Results: The final consensus document contained 47 voted statements, across six key domains of perioperative and anaesthetic
management in pelvic exenteration, comprising preoperative assessment and preparation, anaesthetic considerations, perioperative
management, anticipating possible massive haemorrhage, stress response and postoperative critical care, and pain management.
Consensus recommendations were developed, based on consensus agreement achieved on 34 statements.
Conclusion: The perioperative and anaesthetic management of patients undergoing pelvic exenteration is best accomplished by
a dedicated multidisciplinary team with relevant domain expertise in the setting of a specialized tertiary unit. This consensus
statement has addressed key domains within the framework of current perioperative and anaesthetic management among patients
undergoing pelvic exenteration, with an international perspective, to guide clinical practice, and has outlined areas for future clinical
research.
Perioperative management and anaesthetic considerations in pelvic exenterations using Delphi methodology: results from the PelvEx Collaborative / Chok, A Y; Oliver, A; Rasheed, S; Tan, E J; Kelly, M E; Aalbers, A G J; Abdul Aziz, N; Abecasis, N; Abraham-Nordling, M; Akiyoshi, T; Alberda, W; Albert, M; Andric, M; Angenete, E; Antoniou, A; Auer, R; Austin, K K; Aziz, O; Baker, R P; Bali, M; Baseckas, G; Bebington, B; Bedford, M; Bednarski, B K; Beets, G L; Berg, P L; Beynon, J; Biondo, S; Boyle, K; Bordeianou, L; Bremers, A B; Brunner, M; Buchwald, P; Bui, A; Burgess, A; Burger, J W A; Burling, D; Burns, E; Campain, N; Carvalhal, S; Castro, L; Caycedo-Marulanda, A; Chan, K K L; Chang, G J; Chew, M H; Chong, P; Christensen, H K; Clouston, H; Codd, M; Collins, D; Colquhoun, A J; Corr, A; Coscia, M; Coyne, P E; Creavin, B; Croner, R S; Damjanovic, L; Daniels, I R; Davies, M; Davies, R J; Delaney, C P; de Wilt, J H W; Denost, Q; Deutsch, C; Dietz, D; Domingo, S; Dozois, E J; Duff, M; Eglinton, T; Enrique-Navascues, J M; Espin-Basany, E; Evans, M D; Fearnhead, N S; Flatmark, K; Fleming, F; Frizelle, F A; Gallego, M A; Garcia-Granero, E; Garcia-Sabrido, J L; Gentilini, L; George, M L; George, V; Ghouti, L; Giner, F; Ginther, N; Glynn, R; Golda, T; Griffiths, B; Harris, D A; Hagemans, J A W; Hanchanale, V; Harji, D P; Helewa, R M; Hellawell, G; Heriot, A G; Hochman, D; Hohenberger, W; Holm, T; Holmström, A; Hompes, R; Jenkins, J T; Kaffenberger, S; Kandaswamy, G V; Kapur, S; Kanemitsu, Y; Kelley, S R; Keller, D S; Khan, M S; Kim, H; Kim, H J; Koh, C E; Kok, N F M; Kokelaar, R; Kontovounisios, C; Kristensen, H Ø; Kroon, H M; Kusters, M; Lago, V; Larsen, S G; Larson, D W; Law, W L; Laurberg, S; Lee, P J; Limbert, M; Lydrup, M L; Lyons, A; Lynch, A C; Mantyh, C; Mathis, K L; Margues, C F S; Martling, A; Meijerink, W J H J; Merkel, S; Mehta, A M; McArthur, D R; McDermott, F D; McGrath, J S; Malde, S; Mirnezami, A; Monson, J R T; Morton, J R; Mullaney, T G; Negoi, I; Neto, J W M; Nguyen, B; Nielsen, M B; Nieuwenhuijzen, G A P; Nilsson, P J; O’Dwyer, S T; Palmer, G; Pappou, E; Park, J; Patsouras, D; Pellino, G; Peterson, A C; Poggioli, G; Proud, D; Quinn, M; Quyn, A; Radwan, R W; Rasmussen, P C; Rausa, E; Regenbogen, S E; Renehan, A; Rocha, R; Rochester, M; Rohila, J; Rothbarth, J; Rottoli, M; Roxburgh, C; Rutten, H J T; Ryan, É J; Safar, B; Sagar, P M; Sahai, A; Saklani, A; Sammour, T; Sayyed, R; Schizas, A M P; Schwarzkopf, E; Scripcariu, V; Selvasekar, C; Shaikh, I; Shida, D; Simpson, A; Smart, N J; Smart, P; Smith, J J; Solbakken, A M; Solomon, M J; Sørensen, M M; Steele, S R; Steffens, D; Stitzenberg, K; Stocchi, L; Stylianides, N A; Swartling, T; Sumrien, H; Sutton, P A; Swartking, T; Taylor, C; Teras, J; Thurairaja, R; Toh, E L; Tsarkov, P; Tsukada, Y; Tsukamoto, S; Tuech, J J; Turner, W H; Tuynman, J B; Ramshorst, G H van; Zoggel, D van; Vasquez-Jimenez, W; Verhoef, C; Vizzielli, G; Voogt, E L K; Uehara, K; Wakeman, C; Warrier, S; Wasmuth, H H; Weber, K; Weiser, M R; Wheeler, J M D; Wild, J; Wilson, M; Wolthuis, A; Yano, H; Yip, B; Yip, J; Yoo, R N; Winter, D C; Tekkis, P P. - In: BJS OPEN. - ISSN 2474-9842. - ELETTRONICO. - 5:1(2021), pp. zraa055.1-zraa055.10. [10.1093/bjsopen/zraa055]
Chok, A Y; Oliver, A; Rasheed, S; Tan, E J; Kelly, M E; Aalbers, A G J; Abdul Aziz, N; Abecasis, N; Abraham-Nordling, M; Akiyoshi, T; Alberda, W; Albert, M; Andric, M; Angenete, E; Antoniou, A; Auer, R; Austin, K K; Aziz, O; Baker, R P; Bali, M; Baseckas, G; Bebington, B; Bedford, M; Bednarski, B K; Beets, G L; Berg, P L; Beynon, J; Biondo, S; Boyle, K; Bordeianou, L; Bremers, A B; Brunner, M; Buchwald, P; Bui, A; Burgess, A; Burger, J W A; Burling, D; Burns, E; Campain, N; Carvalhal, S; Castro, L; Caycedo-Marulanda, A; Chan, K K L; Chang, G J; Chew, M H; Chong, P; Christensen, H K; Clouston, H; Codd, M; Collins, D; Colquhoun, A J; Corr, A; Coscia, M; Coyne, P E; Creavin, B; Croner, R S; Damjanovic, L; Daniels, I R; Davies, M; Davies, R J; Delaney, C P; de Wilt, J H W; Denost, Q; Deutsch, C; Dietz, D; Domingo, S; Dozois, E J; Duff, M; Eglinton, T; Enrique-Navascues, J M; Espin-Basany, E; Evans, M D; Fearnhead, N S; Flatmark, K; Fleming, F; Frizelle, F A; Gallego, M A; Garcia-Granero, E; Garcia-Sabrido, J L; Gentilini, L; George, M L; George, V; Ghouti, L; Giner, F; Ginther, N; Glynn, R; Golda, T; Griffiths, B; Harris, D A; Hagemans, J A W; Hanchanale, V; Harji, D P; Helewa, R M; Hellawell, G; Heriot, A G; Hochman, D; Hohenberger, W; Holm, T; Holmström, A; Hompes, R; Jenkins, J T; Kaffenberger, S; Kandaswamy, G V; Kapur, S; Kanemitsu, Y; Kelley, S R; Keller, D S; Khan, M S; Kim, H; Kim, H J; Koh, C E; Kok, N F M; Kokelaar, R; Kontovounisios, C; Kristensen, H Ø; Kroon, H M; Kusters, M; Lago, V; Larsen, S G; Larson, D W; Law, W L; Laurberg, S; Lee, P J; Limbert, M; Lydrup, M L; Lyons, A; Lynch, A C; Mantyh, C; Mathis, K L; Margues, C F S; Martling, A; Meijerink, W J H J; Merkel, S; Mehta, A M; McArthur, D R; McDermott, F D; McGrath, J S; Malde, S; Mirnezami, A; Monson, J R T; Morton, J R; Mullaney, T G; Negoi, I; Neto, J W M; Nguyen, B; Nielsen, M B; Nieuwenhuijzen, G A P; Nilsson, P J; O’Dwyer, S T; Palmer, G; Pappou, E; Park, J; Patsouras, D; Pellino, G; Peterson, A C; Poggioli, G; Proud, D; Quinn, M; Quyn, A; Radwan, R W; Rasmussen, P C; Rausa, E; Regenbogen, S E; Renehan, A; Rocha, R; Rochester, M; Rohila, J; Rothbarth, J; Rottoli, M; Roxburgh, C; Rutten, H J T; Ryan, É J; Safar, B; Sagar, P M; Sahai, A; Saklani, A; Sammour, T; Sayyed, R; Schizas, A M P; Schwarzkopf, E; Scripcariu, V; Selvasekar, C; Shaikh, I; Shida, D; Simpson, A; Smart, N J; Smart, P; Smith, J J; Solbakken, A M; Solomon, M J; Sørensen, M M; Steele, S R; Steffens, D; Stitzenberg, K; Stocchi, L; Stylianides, N A; Swartling, T; Sumrien, H; Sutton, P A; Swartking, T; Taylor, C; Teras, J; Thurairaja, R; Toh, E L; Tsarkov, P; Tsukada, Y; Tsukamoto, S; Tuech, J J; Turner, W H; Tuynman, J B; Ramshorst, G H van; Zoggel, D van; Vasquez-Jimenez, W; Verhoef, C; Vizzielli, G; Voogt, E L K; Uehara, K; Wakeman, C; Warrier, S; Wasmuth, H H; Weber, K; Weiser, M R; Wheeler, J M D; Wild, J; Wilson, M; Wolthuis, A; Yano, H; Yip, B; Yip, J; Yoo, R N; Winter, D C; Tekkis, P P
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/803417
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simulazione ASN
Il report seguente simula gli indicatori relativi alla propria produzione scientifica in relazione alle soglie ASN 2023-2025 del proprio SC/SSD. Si ricorda che il superamento dei valori soglia (almeno 2 su 3) è requisito necessario ma non sufficiente al conseguimento dell'abilitazione. La simulazione si basa sui dati IRIS e sugli indicatori bibliometrici alla data indicata e non tiene conto di eventuali periodi di congedo obbligatorio, che in sede di domanda ASN danno diritto a incrementi percentuali dei valori. La simulazione può differire dall'esito di un’eventuale domanda ASN sia per errori di catalogazione e/o dati mancanti in IRIS, sia per la variabilità dei dati bibliometrici nel tempo. Si consideri che Anvur calcola i valori degli indicatori all'ultima data utile per la presentazione delle domande.
La presente simulazione è stata realizzata sulla base delle specifiche raccolte sul tavolo ER del Focus Group IRIS coordinato dall’Università di Modena e Reggio Emilia e delle regole riportate nel DM 589/2018 e allegata Tabella A. Cineca, l’Università di Modena e Reggio Emilia e il Focus Group IRIS non si assumono alcuna responsabilità in merito all’uso che il diretto interessato o terzi faranno della simulazione. Si specifica inoltre che la simulazione contiene calcoli effettuati con dati e algoritmi di pubblico dominio e deve quindi essere considerata come un mero ausilio al calcolo svolgibile manualmente o con strumenti equivalenti.