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

Abstract

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.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Fluid and temperature remain the culprit!

“…[ 17 ] The fluid management was guided by non-invasive continuous cardiac output monitoring with FloTrac in patients with high tumour load and patient having persistent haemodynamic perturbations in the study being published. [ 10 ] Another randomised controlled trial which studied various outcomes related to CRS and HIPEC reported that the use of a goal-directed fluid therapy using the FloTrac/Vigileo was associated with improved patient-related outcome for major abdominal and systemic post-operative complications and reduced length of hospital stay. [ 18 ] The less-invasive haemodynamic monitoring devices such as the oesophageal Doppler may be useful; however, the tool and its utility though proven in other surgical interventions but has not been assessed in CRS and HIPEC.…”

“…A balanced fluid management protocol would maintain colloid oncotic pressure and urinary output. [ 10 ] Colloids replenish intravascular volume in a ratio of 1:1 in a fluid responsive patient and may be used to maintain Optovolaemia. Such surgeries lead to protein loss owing to ascites drainage and extensive tissue handling and cytoreduction.…”

“…The authors have used vasopressors (dopamine, noradrenaline and adrenaline) in addition to gelatin, blood products as per need. [ 10 ] The use of dopamine as the first choice with an intent to increase renal perfusion has been described in this study. [ 10 ] The loop diuretics have been used to increase urine output to mitigate nephrotoxic insult by the chemotherapeutic agent used in HIPEC.…”

“…This issue publishes two manuscripts related to the use of intraoperative intraperitoneal chemotherapy during oncosurgery. [ 10 11 ] In a retrospective analysis, the authors have assessed factors associated with morbidity and mortality after CRS and HIPEC. [ 10 ] The other manuscript describes a case undergoing CRS and PIPAC.…”

“…[ 10 11 ] In a retrospective analysis, the authors have assessed factors associated with morbidity and mortality after CRS and HIPEC. [ 10 ] The other manuscript describes a case undergoing CRS and PIPAC. [ 11 ]…”