Early and long-term postoperative management following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Abstract

Peritoneal surface malignancies have been traditionally regarded as end-stage conditions amenable to merely palliative options. The combination of aggressive cytoreductive surgery (CRS), involving peritonectomy procedures and multivisceral resections, with intraoperative hyperthermic intra-peritoneal chemotherapy (HIPEC) and/or early postoperative intra-peritoneal chemotherapy (EPIC) to treat the microscopic residual tumor is a new concept. In recent years, promising results have been reported for peritoneal mesothelioma and carcinomatosis of gastrointestinal and gynaecologic origin treated by this combined protocol. However, CRS with HIPEC and/or EPIC is a complex procedure associated with high rates of potentially life-threatening complications. Furthermore, disease progression following comprehensive treatment is not uncommon and represents a relevant cause of treatment failure. The present paper reviews the available information on early postoperative management and long-term follow-up in patients treated with CRS and intraperitoneal chemotherapy. The peculiar clinical and biological alterations that can be expected during an uncomplicated postoperative course, as compared to standard digestive surgery, are discussed. Early recognition and appropriate management of the most common adverse events are addressed, in order to minimize the impact of treatment-related morbidity on survival and quality of life results. Since re-operative surgery with additional HIPEC, has proven to be useful in selected patients with recurrent disease, long-term surveillance aiming at early detection of postoperative disease progression has become a relevant issue. Current results on follow-up investigations are presented.

Complications of Cytoreductive Surgery and HIPEC in the Treatment of Peritoneal Metastases

“…Small bowel perforations and anastomotic leaks are the most common and clinically significant GI complications after CRS and HIPEC. A possible explanation for digestive non-anastomotic perforation could be partial-thickness mechanical damage to intestinal surfaces, focal heat injury at the tip of the inflow catheters, suctioning effect of the outflow catheter, or postoperative shrinking of infiltrating metastatic nodules on the intestinal wall because of the antiblastic effect of HIPEC [19]. The risk for such complications should be minimized by careful lyses of adhesions and dissection, with a judicious use of the ball-tip electro-cautery when used for dissection of superficial peritoneal lesions.…”

Hematological toxicities associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

“…The main systemic complications are infectious, renal, thrombotic, and hematologic in nature . The high morbidity is often related to the extensive visceral resections; however, they are also contributed to by the local and systemic toxicities of the heated intraperitoneal chemotherapy.…”

Sitoreduktif Cerrahi ve HIPEK’te Anestezi ve Perioperatif Bakim

“…Hastaların büyük çoğunluğunda postoperatif 1. ve 2.günlerde vücut sıcaklığının 37.7 ile 37.9 C arasında seyrettiği ve sonrasında normalize olduğu gözlemlenmiştir (25). Baratti ve arkadaşları ise sepsis bulguları olmamasına rağmen hastaların bazılarında postoperatif 10 gün boyunca sıcaklığın 38 C'ye kadar yükseldiğini rapor etmişlerdir (39).…”