Best practice for perioperative management of patients with cytoreductive surgery and HIPEC

Raspé, Christoph; Flöther, Lilit; Schneider, R.; Bucher, Michael; Piso, Pompiliu

doi:10.1016/j.ejso.2016.09.008

Cited by 105 publications

(153 citation statements)

References 143 publications

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“…Unlike laparoscopic colorectal surgery, few prospective studies have focused on the effects of epidural analgesia on postoperative recovery after VATS. Optimal pain management, especially in the first three PODs, is the most important consideration after thoracic surgery . Patient‐controlled epidural analgesia provided better analgesia and more rapid recovery from ileus after colon surgery than IV PCA morphine .…”

Section: Discussionmentioning

confidence: 99%

Improvement of recovery parameters using patient‐controlled epidural analgesia for video‐assisted thoracoscopic surgery lobectomy in enhanced recovery after surgery: A prospective, randomized single center study

et al. 2018

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BackgroundWe compared the effects of thoracic epidural analgesia (TEA) to conventional patient‐controlled analgesia (PCA) on several postoperative parameters of recovery after elective video‐assisted thoracoscopic (VATS) lobectomy.MethodsNinety‐eight patients undergoing elective VATS lobectomy were enrolled. The primary endpoint was pain score. Recovery of bowel function, length of stay in the postanesthesia care unit (PACU), duration of postoperative hospital stay, and complications were assessed. Continuous variables were expressed and compared between groups using either a two‐tailed Student's t or Mann‐Whitney U test. Recovery of bowel function was compared using the log‐rank test.ResultsBaseline characteristics between the groups were similar. Dynamic pain scores on postoperative days (PODs) 0–2 were significantly lower in the TEA group, as were resting pain scores on PODs 1 and 2 (P < 0.05). The mean duration to first flatus (16 ± 0.7 vs. 26 ± 0.7 hours; P < 0.001) and the mean length of stay in the PACU (34 vs. 67 minutes; P = 0.027) were shorter in the TEA compared to the PCA group, respectively. The only difference in postoperative complications was regarding confusion (5 TEA vs. 18 PCA patients; P = 0.002). No difference in overall length of stay was noted.ConclusionsCompared to PCA, TEA provided better postoperative pain control after VATS lobectomy and facilitated postoperative recovery of bowel function without increasing the length of hospital stay. This beneficial effect of TEA might be attributed to the attenuation of sympathetic hyperactivation, improved analgesia, and reduced opioid use.

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Section: Discussionmentioning

confidence: 99%

Improvement of recovery parameters using patient‐controlled epidural analgesia for video‐assisted thoracoscopic surgery lobectomy in enhanced recovery after surgery: A prospective, randomized single center study

et al. 2018

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“…The surgical oncologist or primary care physician should ensure that patients are nutritionally optimized before surgery, which may be difficult for patients experiencing gastrointestinal disturbances from their cancer or systemic chemotherapy. Oral nutritional supplements can circumvent the patient's inability to tolerate food; however, when all else fails, the patient should receive parenteral nutrition …”

Section: Preoperative Patient Care and Preparationmentioning

confidence: 99%

“…An albumin level provides a good assessment of the patient's nutritional status: improving preoperative hypoalbuminemia is an independent predictor for preventing severe postoperative complications and a prognostic parameter for overall survival in surgical cancer patients . Iron‐deficiency anemia also is associated with postoperative morbidity and mortality and should be corrected before elective surgery to avoid adverse effects, the need for a blood transfusion, or both . A malnourished state can complicate incision healing, increase the risk of postoperative infections, and lengthen hospital stays …”

Section: Preoperative Patient Care and Preparationmentioning

confidence: 99%

“…Cytoreductive surgery may take hours, depending on the amount of macroscopic tumor(s) to be removed. If gastrointestinal reconstruction or diversion is required, the surgeon usually performs these procedures after HIPEC to prevent encapsulating cancer cells in the suture line or staple . After tumor debulking, the surgeon irrigates the cavity to remove loose tissue and fat to prevent the hyperthermia perfusion pump's filtered reservoir from becoming clogged during use.…”

Section: Intraoperative Patient Carementioning

confidence: 99%

“…The surgeon then reopens the incision and removes the catheters and temperature probes. If a bowel resection is needed, this is the ideal time to perform this procedure because the tumor burden is at its lowest level . The scrub person then prepares for the closing count.…”

Section: Intraoperative Patient Carementioning

confidence: 99%

See 2 more Smart Citations

Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy, Part II: Implementation

Dunn¹,

Ciccarelli²,

Moltzen³

2019

AORN Journal

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Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is an extensive procedure used to treat peritoneal carcinomatosis, which is either primary or secondary to other cancers (eg, ovarian, colorectal, appendiceal) that have metastasized to the peritoneum. Morbidity, mortality, and quality of life have improved for patients selecting CRS with HIPEC as a cancer treatment. At Holy Name Medical Center in Teaneck, New Jersey, an interdisciplinary team was established to plan and coordinate performing this new procedure in the OR. The team created a written protocol for implementing CRS with HIPEC before patients were scheduled for surgery. This article explores the perioperative facets of implementing CRS with HIPEC and discusses care of the patient undergoing CRS with HIPEC, with a focus on perioperative nursing considerations.

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Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy, Part I: Introduction and Indications

Dunn¹

2019

AORN Journal

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Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is used to treat peritoneal carcinomatosis, which often is secondary to gastrointestinal and ovarian cancers. During CRS, the surgeon resects cancerous tumors from the peritoneal cavity. During HIPEC, a chemotherapy agent is introduced into a solution that flows in and out of catheters in the abdominal cavity for approximately 90 minutes. The chemoperfusate is heated to 42° C (107.6° F), which kills cancer cells but is nonthreatening to normal cells. A primary goal of combining CRS with HIPEC is to apply targeted regional chemotherapy directly to the peritoneum to destroy residual micrometastatic disease while the tumor burden is minimal and before cancer cells become entrapped by the body's wound‐healing processes. Although HIPEC usually is not curative, it can extend a patient's life expectancy three to five years. This is the first article in a two‐part discussion of CRS with HIPEC.

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Best practice for perioperative management of patients with cytoreductive surgery and HIPEC

Cited by 105 publications

References 143 publications

Improvement of recovery parameters using patient‐controlled epidural analgesia for video‐assisted thoracoscopic surgery lobectomy in enhanced recovery after surgery: A prospective, randomized single center study

Improvement of recovery parameters using patient‐controlled epidural analgesia for video‐assisted thoracoscopic surgery lobectomy in enhanced recovery after surgery: A prospective, randomized single center study

Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy, Part II: Implementation

Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy, Part I: Introduction and Indications

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