Fluid administration in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: neither too much nor too little

Garijo, Maria Elvira Castellanos; Blanco, A.; González, José Tinoco; Casado, Alicia Merinero; Moya, Juan Ignacio Medina de; Vidal, Gabriel Yanes; Rodriguez, Ana Forastero; García, Cristobalina Ángeles Martín; Muñoz-Casares, F.C.; Padillo-Ruíz, Javier

doi:10.1016/j.bjane.2021.07.018

Cited by 1 publication

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“…Although goal fluid therapy is one of the mainstays of the ERAS program [49][50][51], concerns about HIPEC-induced nephrotoxicity and the replacement of large-volume ascites led to a liberal fluid management. In some studies, the fluid restriction was associated with a higher percentage of major postoperative complications [52] while in other analyses it's linked to a shorter LOS and lower postoperative morbidity rate without increasing the rate of acute kidney injury or renal dysfunction [53]. In spite of the fact that certain agents utilized for HIPEC as cisplatin are linked to a greater risk of renal injury, in this meta-analysis no difference in terms of postoperative complications are related to the chemotherapic drug used; moreover, in the study published by White [23], cisplatin administration was strongly associated with acute kidney injury before ERAS but not afterward.…”

Section: Discussionmentioning

confidence: 99%

Enhanced Recovery after Surgery (ERAS) Program for Patients with Peritoneal Surface Malignancies Undergoing Cytoreductive Surgery with or without HIPEC: A Systematic Review and a Meta-Analysis

Robella

Tonello

Berchialla³

et al. 2023

Cancers

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Enhanced recovery after surgery (ERAS) program refers to a multimodal intervention to reduce the length of stay and postoperative complications; it has been effective in different kinds of major surgery including colorectal, gynaecologic and gastric cancer surgery. Its impact in terms of safety and efficacy in the treatment of peritoneal surface malignancies is still unclear. A systematic review and a meta-analysis were conducted to evaluate the effect of ERAS after cytoreductive surgery with or without HIPEC for peritoneal metastases. MEDLINE, PubMed, EMBASE, Google Scholar and Cochrane Database were searched from January 2010 and December 2021. Single and double-cohort studies about ERAS application in the treatment of peritoneal cancer were considered. Outcomes included the postoperative length of stay (LOS), postoperative morbidity and mortality rates and the early readmission rate. Twenty-four studies involving 5131 patients were considered, 7 about ERAS in cytoreductive surgery (CRS) + HIPEC and 17 about cytoreductive alone; the case histories of two Italian referral centers in the management of peritoneal cancer were included. ERAS adoption reduced the LOS (−3.17, 95% CrI −4.68 to −1.69 in CRS + HIPEC and −1.65, 95% CrI −2.32 to –1.06 in CRS alone in the meta-analysis including 6 and 17 studies respectively. Non negligible lower postoperative morbidity was also in the meta-analysis including the case histories of two Italian referral centers. Implementation of an ERAS protocol may reduce LOS, postoperative complications after CRS with or without HIPEC compared to conventional recovery.

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