They have been posted on Cancers the results of a clinical study conducted by the team of Thoracic Surgery of the IRCCS Humanitas Clinical Institute. Surgeons have developed a protocol, New Eras (Enhanced Recovery After Surgery), which consists in following remotely, with telemedicine, patients discharged after robotic surgery for lobectomy (lung resection, typically for a tumour) thanks to special electronic devices. The aim of the study was the validation of this pathway, with an indication of the benefits for the patients.
«The program started in 2022 – explains Prof. Marco Alloisio, head of Thoracic Surgery of the IRCCS Humanitas Clinical Institute – as a response to the needs caused by the pandemic, which has prompted hospitals to reorganize their paths to protect the most fragile people, such as cancer patients. Even in the surgical field, technology has proven to be a solution for reducing the stay in the ward, protecting the safety of patients».
The basis of the program is robotic lung surgery which, due to its minimally invasive characteristics, favors a better post-operative recovery. Hence the idea of following patients at home after discharge, managing to reduce hospital stay days to 2 compared to an average of 5 with traditional surgery.
The advantages of the New Eras protocol
«The protocol – explains its creator and coordinator, Dr. Edward Buttons, thoracic surgeon of the Robotic Surgery program of the IRCCS Istituto Clinico Humanitas – involved patients aged between 18 and 75 with lung cancer and scheduled for robotic surgery. All had a helper at home (caregiver) and were able to interact with the electronic device used for the televisite. The advantages found are: better recovery after surgery and less pain thanks to the remote support of the anesthesiologists. The patients also confirmed how easy it is to follow the instructions of the medical and nursing staff from home”.
Last but not least, the New Eras protocol has demonstrated the sustainability of robotic surgery programs in terms of both machine costs (in proportion to hospitalization times) and speed of access to surgical interventions for patients.
The multidisciplinarity typical of Cancer Centers is the fundamental ingredient for making this approach possible, which requires the commitment of surgeons, doctors, nurses, physiotherapists and anesthesiologists.
How the new surgical procedure for lung cancer works
Before the operation, the patient and his companion come educated in detail by medical staff on the use of the device provided by the hospital. «The tests with smartphone and electronic device are carried out together to verify that everything works – continues Dr. Bottoni -. On discharge day, usually 48 hours after robotic surgery, patients go home with drainage. The device allows direct contact with doctors and nurses, useful for pain monitoring and management. In the letter of resignation, in addition to all the instructions to follow, there is a dedicated number for emergencies or information”.
Once at home, on the first day every 4 hours, the patient must measure the required parameters: pressure, saturation, heart rate, temperature. Drainage is always managed via device in televisit with the support of the doctor. On the second day, the parameters are measured again. On the third or fourth day we go back to the hospital to remove the drainage (subject to a medical decision on televisit).
The normal follow up follows: medication in hospital after two weeks and delivery of the histological examination.
To ensure patient safety, a dedicated Emergency Department path has been set up to manage any critical cases that have not been encountered. Similarly, patients requiring intensive care, for whom discharge within 48 hours is not possible, are not included in the protocol.
The numbers from cancer in Italy
It is estimated that 390,700 people received a new cancer diagnosis in 2022 with an increase of 14,100 cases in two years, according to the Report “The numbers of cancer in Italy 2022” (AIOM data). In our country, the most frequent neoplasms in the general population, increasing compared to 2020, are the breast cancer (+0,5%), il colorectal cancer (+1.5% in men and +1.6% in women), the lung cancer (+1.6% in men and +3.6% in women), the prostate cancer (+1.5%), which is the most frequent among males, and the bladder cancer (+1.7% in men and +1.0% in women). After breast, colorectal and lung, the most frequent cancers in women areendometrium and of thyroidwhile for males, the most affected organs are prostate, lung, colorectal, bladder and stomach.
Humanitas numbers