Anesthetic management in patients undergoing hyperthermic chemotherapy

Raspé, Christoph; Piso, P.; Wiesenack, Christoph; Bucher, Michael

doi:10.1097/aco.0b013e32835347b2

Cited by 85 publications

(88 citation statements)

References 64 publications

(80 reference statements)

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“…Blood glucose should be monitored at the completion of chemo delivery, and occasionally a single dose of insulin may be required. Similar to other reports (14) the patients were transferred to the ICU intubated, being extubated in the first 12 hours postoperative period. Postoperative analgesia was achieved with a combination of boluses of opioids and local anaesthetics through the epidural catheter, and multimodal analgesia.…”

Section: Surgical Techniquesupporting

confidence: 67%

“…Another important issue which should be taken in consideration in peritoneal carcinomatosis with gastric cancer origin is the timing of the apparition of the peritoneal lesions; it has been stipulated that patients developing peritoneal carcinomatosis at a certain point of their evolution present in fact a more aggressive biology of the tumor which could not be controlled by the previous administrated treatment and might have a poorer response to HIPEC (14). Oppositely, patients presenting peritoneal carcinomatosis at the moment of the initial diagnosis seem to have a better outcome if cytoreductive surgery to no residual disease and HIPEC are associated.…”

Section: Discussionmentioning

confidence: 99%

“…Bair-Hugger warming and warming infusion devices were used. Three units of cross-matched blood and fresh frozen plasma were available for use (13,14). Peritonectomy with HIPEC can be divided into two phases, the cyto-reduction phase and the HIPEC phase (15).…”

Section: Surgical Techniquementioning

confidence: 99%

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Laparoscopic HIPEC for Peritoneal Carcinomatosis from Gastric Cancer - Technique and Early Outcomes of Our First Cases

Bălescu¹,

Godoroja²,

Gongu³

et al. 2017

chr

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RezumatCancerul gastric rămâne una din cele mai agresive malignităţi, fiind asociat cu rezultate terapeutice nesatisfăcătoare, în special la pacienţii cu boală avansată. Din cauza acestui aspect atenţia comunităţii medicale actuale este concentrată în a identifica un tratament mai bun, un control mai eficient al bolii şi în a îmbunătăţi ratele de supravieţuire. Odată ce beneficiile chirurgiei citoreductive în asociere cu hipertermia intraperitoneală (HIPEC) au fost demonstrate pe scală largă la pacienţii diagnosticaţi cu carcinomatoză peritoneală din origine colorectală sau ovariană, atenţia a fost axată pe posibila utilizare a acestei metode la pacienţii diagnosticaţi cu carcinomatoză peritoneală de origine gastrică. Mai mult decât atât, prin utilizarea laparoscopiei pentru efectuarea chirurgiei citoreductive (L-CRS) în asociere cu chimioterapia hipertermică intraperitoneală (L-HIPEC), se aşteaptă ca beneficiile intervenţiei chirurgicale minimal invazive (MIS) să contribuie la îmbunătăţirea rezultatelor postoperatorii. În acest mod, pacienţii beneficiază de o administrare mai rapidă a tratamentului chimioterapeutic adjuvant ori de câte ori este necesar. Scop: de a prezenta tehnica L-CRS + L-HIPEC şi rezultatele obţinute într-o serie de cazuri de doi pacienţi diagnosticaţi cu carcinomatoză peritoneală din cancerul gastric. Metodă: În toate cazurile, a fost efectuată o procedură completă de investigare, incluzând laparoscopia exploratorie pentru evaluarea Indexului de Carcinomatoză Peritoneală (PCI). Consiliul Surgical TechniqueChirurgia (2017) AbstractGastric cancer remains one of the most aggressive malignancies, being associated with very poor therapeutic outcomes, especially in the advanced disease patients. Due to this evidence, finding a better treatment, a better control and higher survival rates is the current scientific focus of the medical community. Once the benefits of cytoreductive surgery in association with intraperitoneal hyperthermy (HIPEC) have been widely demonstrated in patients presenting peritoneal carcinomatosis from colorectal or ovarian origin,attention was focused on the possible benefit of this method in patients diagnosed with peritoneal carcinomatosis with gastric origin. Moreover, using laparoscopy for the cytoreductive surgery (L-CRS) and hyperthermic intraperitoneal chemotherapy (L-HIPEC), the advantages of minimal invasive surgery (MIS) are expected to contribute to improved postoperative outcomes. In this way, the patients benefit from a faster administration of the adjuvant chemotherapeutic treatment, whenever is necessary. Aim: to present the technique of L-CRS + L-HIPEC and the early therapeutic outcomes in a case series of two patients diagnosed with peritoneal carcinomatosis from gastric cancer. Method: A complete investigational work-up including diagnostic laparoscopy to evaluate the Peritoneal Carcinomatosis Index (PCI) was fulfilled in all the cases. The institutional Tumor Board decided the therapeutic strategy: laparoscopic radical resection and HIPEC (L-CRS +L-HIPEC)...

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Section: Surgical Techniquesupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

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Laparoscopic HIPEC for Peritoneal Carcinomatosis from Gastric Cancer - Technique and Early Outcomes of Our First Cases

Bălescu¹,

Godoroja²,

Gongu³

et al. 2017

chr

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“…Anaesthetic management was performed according to hospital protocols, adjusted to the special demands of CRS and HIPEC, [7][8][9] and patients' individual features. All the patients were operated on by the same surgical team.…”

Section: Cytoreductive Surgery and Hipec Proceduresmentioning

confidence: 99%

Serum lactate as predictor of morbidity, mortality and long term survival in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Spiliotis

Halkia

Zouridis

et al. 2015

CSS

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Introduction: Serum lactate elevation has been used as a marker of tissue hypoxia in the setting of perioperative monitoring and critical care. It has also been correlated with perioperative morbidity and mortality. Cytoreductive surgery (CRS) & hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of peritoneal carcinomatosis is a major abdominal operation, requiring meticulous perioperative care. The aim of this study is to assess the clinical use of lactate measurements after CRS & HIPEC and its prognostic value in terms of immediate postoperative morbidity and mortality, as well as long term survival. Material & Methods: Of 140 patients diagnosed with peritoneal carcinomatosis who underwent cytoreductive surgery and HIPEC were prospectively studied. Serum lactate was measured by air blood gases analyser intraoperatively (just before the administration of HIPEC) and then daily till the fifth postoperative day. Postoperative complications were recorded and divided into two groups according to Clavien Dindo classification. Results: Intraoperative lactate measurements have not been associated with postoperative morbidity and mortality. On the other hand, lactate measurements on postoperative days 3 and 4 are of clinical significance. Specifically, an increase of 1 mmol/L of the average lactate value of days 3 and 4 raises the risk of a minor complication (Grades I to IIIa) by 1.9, the risk of a major complication (Grades IIIb to V) by 10.9 and the risk of mortality by 32.1%. Conclusions: The average of day 3 and 4 postoperative day lactate level is an independent predictor of morbidity and mortality in patients undergoing CRS and HIPEC.

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“…However, it comes with its own risks of nephrotoxicity and coagulopathy and in a changed scenario whether Plasmalyte-A will perform better in these patients remains to be seen. Patients who have large volume ascites/require extensive surgical debulking would benefit more with albumin as opposed to hydroxyl ethyl starches [20].…”

Section: Fluid Management During Hipecmentioning

confidence: 99%

Preoperative Preparation and Patient Selection for Cytoreductive Surgery and HIPEC

Rangole

Nikhilesh²

2016

Indian J Surg Oncol

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Anesthetic management in patients undergoing hyperthermic chemotherapy

Cited by 85 publications

References 64 publications

Laparoscopic HIPEC for Peritoneal Carcinomatosis from Gastric Cancer - Technique and Early Outcomes of Our First Cases

Laparoscopic HIPEC for Peritoneal Carcinomatosis from Gastric Cancer - Technique and Early Outcomes of Our First Cases

Serum lactate as predictor of morbidity, mortality and long term survival in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Preoperative Preparation and Patient Selection for Cytoreductive Surgery and HIPEC

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