Base Excess as a Predictor of Complications in Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy

Eng, Oliver S.; Dumitra, Sinziana; O’Leary, Michael P.; Wakabayashi, Mark T.; Dellinger, Thanh H.; Han, Ernest; Lee, Stephen J.; Paz, I. Benjamin; Singh, Gaurav; Lee, Byrne

doi:10.1245/s10434-017-5869-4

Cited by 10 publications

(6 citation statements)

References 19 publications

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“…Base excess and serum lactate at the end of CRS-HIPEC and the delta base excess at 48 h is quoted as a predictor of complications in CRS-HIPEC,[ 24 ] but in our cohort, the base excess or the lactate levels did not predict the length of ICU stay. Lactate levels during HIPEC were associated with prolonged ventilation ( P = 0.0186).…”

Section: Discussioncontrasting

confidence: 67%

Anaesthetic management and perioperative outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: A retrospective analysis

Balakrishnan¹,

Survesan²

2018

Indian J Anaesth

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Background and Aims:Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is becoming the standard treatment option for peritoneal carcinomatosis but is associated with high rates of morbidity and mortality. Our aim was to retrospectively analyse and evaluate intra-operative factors associated with morbidity and mortality of CRS and HIPEC.Methods:Intra-operative data were collected for cases done over 1 year (24 cases) and analysed for the primary outcome of post-operative ventilation >24 h, and secondary outcome of length of the Intensive Care Unit (ICU) stay >5 days. Statistical analysis was carried out in STATA 11 software.Results:Higher peritoneal carcinoma index (PCI), (P = 0.0047), longer duration of surgery (P = 0.0016), higher delta temperatures (P = 0.0119), increased estimated blood loss (EBL) (P = 0.0054), high intraoperative fluid requirement (P = 0.0038), lower mean arterial pressure (MAP) (P = 0.0021) and higher blood products requirement were associated with >24 h ventilation. These factors were also associated with longer ICU stay. All these factors associated with >24 h ventilation and prolonged ICU stay are related to the PCI which is an indicator of the extent of surgery.Conclusion:Higher PCI, longer duration of surgery, higher delta temperatures, increased EBL, high intraoperative fluid requirement, lower mean arterial pressure and higher blood products requirement were associated with >24 h postoperative ventilation as well as ICU stay >5 days. All these factors are related to the PCI, which is a major predictor of post-operative morbidity.

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Section: Discussioncontrasting

confidence: 67%

Anaesthetic management and perioperative outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: A retrospective analysis

Balakrishnan¹,

Survesan²

2018

Indian J Anaesth

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“…Changes were made to perioperative volume-status and base excess management as evidence emerged. 21 , 22 Length of stay in the intensive care unit (ICU) is not reported given that admission at our institution may not accurately reflect of the severity of postoperative morbidity.…”

Section: Resultsmentioning

confidence: 99%

Impact of Sodium Thiosulfate on Prevention of Nephrotoxicities in HIPEC: An Ancillary Evaluation of Cisplatin-Induced Toxicities in Ovarian Cancer

Senguttuvan,

Santiago,

Han

et al. 2023

Ann Surg Oncol

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Purpose Hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin confers a survival benefit in epithelial ovarian cancer (EOC) but is associated with renal toxicity. Sodium thiosulfate (ST) is used for nephroprotection for HIPEC with cisplatin, but standard HIPEC practices vary. Methods A prospective, nonrandomized, clinical trial evaluated safety outcomes of HIPEC with cisplatin 75 mg/m2 during cytoreductive surgery (CRS) in patients with EOC (n = 34) and endometrial cancer (n = 6). Twenty-one patients received no ST (nST), and 19 received ST. Adverse events (AEs) were reported according to CTCAE v.5.0. Serum creatinine (Cr) was collected preoperatively and postoperatively (Days 5–8). Progression-free survival (PFS) was followed. Normal peritoneum was biopsied before and after HIPEC for whole transcriptomic sequencing to identify RNAseq signatures correlating with AEs. Results Forty patients had HIPEC at the time of interval or secondary CRS. Renal toxicities in the nST group were 33% any grade AE and 9% grade 3 AEs. The ST group demonstrated no renal AEs. Median postoperative Cr in the nST group was 1.1 mg/dL and 0.5 mg/dL in the ST group (p = 0.0001). Median change in Cr from preoperative to postoperative levels were + 53% (nST) compared with − 9.6% (ST) (p = 0.003). PFS did not differ between the ST and nST groups in primary or recurrent EOC patients. Renal AEs were associated with downregulation of metabolic pathways and upregulation of immune pathways. Conclusions ST significantly reduces acute renal toxicity associated with HIPEC with cisplatin in ovarian cancer patients. As nephrotoxicity is high in HIPEC with cisplatin, nephroprotective agents should be considered.

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“…Base excess (BE) has been shown to be a predictor of mortality in patients in the intensive care unit (ICU) after severe trauma 9) and cardiac surgery 10) and a predictor of morbidity after cancer surgery 11) .…”

Section: Introductionmentioning

confidence: 99%

Preoperative Base Excess as a Predictor of Perioperative Complications in Patients with Nonidiopathic Scoliosis who Have High Risk Associated with General Anesthesia

Kanda

Kakutani

Egi

et al. 2023

Spine Surg Relat Res

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We would like to thank Angela Morben, DVM, ELS, from Edanz Group (https://enauthor-services.edanz.com/ac), for editing a draft of this manuscript. Conflicts of Interest:The authors declare that there are no relevant conflicts of interest. Sources of Funding: None. Author Contribution: Y.K. and K.K. were involved in the study concept and design; Y.K., K.K., K.M., Z.Z., T.Y., Y.T., O.H., T.M., and M.R. were involved in the collection and interpretation of data; Y.K. and K.K. were involved in drafting of the manuscript; M.E. and Y.H. were involved in critical revision of the manuscript for important intellectual content; Y.K. and K.K. were involved in the statistical analysis; and M.E. and R.K. were involved in supervision of the study. Ethical approval: This study was conducted under the approval and guidance of the Institutional Review Board (IRB) at Kobe University Graduate School of Medicine (No. B190002, 04/16/2019 approval). Informed Consent: Written informed consent was obtained from all individual participants and/or their legal guardians included in the study. The study was conducted in concordance with the principles of the Declaration of Helsinki and with the laws and regulations of Japan.

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Base Excess as a Predictor of Complications in Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy

Cited by 10 publications

References 19 publications

Anaesthetic management and perioperative outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: A retrospective analysis

Anaesthetic management and perioperative outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: A retrospective analysis

Impact of Sodium Thiosulfate on Prevention of Nephrotoxicities in HIPEC: An Ancillary Evaluation of Cisplatin-Induced Toxicities in Ovarian Cancer

Preoperative Base Excess as a Predictor of Perioperative Complications in Patients with Nonidiopathic Scoliosis who Have High Risk Associated with General Anesthesia

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