Changes in Hepatic Blood Flow and Liver Function during Closed Abdominal Hyperthermic Intraperitoneal Chemotherapy following Cytoreduction Surgery

Abstract

Background The increase in intra-abdominal pressure (IAP) during closed abdominal hyperthermic intraperitoneal chemotherapy (HIPEC) leads to major haemodynamic changes and potential organ dysfunction. We investigated these effects on hepatic blood flow (HBF) and liver function in patients undergoing HIPEC following cytoreductive surgery and fluid management guided by dynamic preload indices. Methods In this prospective observational clinical study including 15 consecutive patients, we evaluated HBF by transesophageal echocardiography and liver function by determination of the indocyanine green plasma disappearance rate (ICG-PDR). Friedman's two-way analysis of variance by ranks and Wilcoxon signed-rank test were performed for statistical analysis. Results During HIPEC, HBF was markedly reduced, resulting in the loss of any pulsatile Doppler flow signal in all but one patient. The ICG-PDR, expressed as median (interquartile 25–75), decreased from 23 (20–30) %/min to 18 (12.5–19) %/min (p < 0.001). Despite a generous crystalloid infusion rate (27 (22–35) ml/kg/h), cardiac index decreased during the increased IAP period, inferior vena cava diameter decreased, stroke volume variation and pulse pressure variation increased, lung compliance dropped, and there was an augmentation in plateau pressure. All changes were significant (p < 0.001) and reversed to baseline values post HIPEC. Conclusion Despite optimizing intravenous fluids during closed abdominal HIPEC, we observed a marked decrease in HBF and liver function. Both effects were transient and limited to the period of HIPEC but could influence the choice between closed or open abdominal cavity procedure for HIPEC and should be considered in similar clinical situations of increased IAP.

HIPEC in Peritoneal Metastasis of Gastric Origin: A Systematic Review of Regimens and Techniques

“…Leiting et al retrospectively analyzed outcome parameters in a cohort of 1812 patients with mostly colorectal and appendiceal peritoneal metastases undergoing CRS and HIPEC. He found neither the open nor the closed technique to be an independent risk factor for post-operative complications or inferior long-term outcome [ 73 ], although others have detected decreased cardiac index, hepatic blood flow, and liver function due to the high abdominal pressure in closed abdomen HIPEC [ 74 ]. Somashekar et al recently compared patients undergoing bowel anastomosis before and after HIPEC and found no significant difference in leakage or perforation rate between the two groups, but in this cohort only 7% pmGC patients were included [ 75 ].…”

The Benefit of Dexmedetomidine on kidney are associated with the inhibition of oxidative stress during hyperthermic intraperitoneal chemotherapy: a randomized trail

“…However, there was no statistical signi cance of liver fuction in our study. This may re ect the relative good tolerance by decreased hepatic blood ow induced by HIPEC [15] . In terms of pathophysiological changes, hepatic artery blood ow increased when portal blood ow reduced maintain partial hepatic blood ow which followed by adequate liver clearance and oxygen supply.…”