New transpulmonary thermodilution approach to assess hemodynamic changes in patients undergoing open abdominal cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

Abstract

Purpose The current treatment of peritoneal cancer combines cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). The present study aimed to use the VolumeView TM system to investigate the intraoperative physiological changes, including extravascular lung water, in patients undergoing cytoreductive surgery with HIPEC. Methods This prospective, observational study enrolled 21 patients undergoing elective cytoreductive surgery with HIPEC at our hospital between December 2014 and April 2016. In all patients, we applied the VolumeView TM system (Edwards Lifesciences, Irvine, CA). Internal jugular vein and femoral artery accesses were required to monitor hemodynamic parameters. Data were recorded and analyzed before skin incision; 30 min before HIPEC initiation; 30, 60, and 90 min after HIPEC initiation; 30 min after HIPEC completion; and 10 min before surgery completion. Results During HIPEC, patients showed a rise in body temperature, decrease in the systemic vascular resistance index, and increase in cardiac output. The global end-diastolic volume index was 715.4–809.7, and the extravascular lung water index was 6.9–7.3. Rapid insulin (mean, 6.8 units) was administered because of increased glucose levels, and lactate levels steadily increased during HIPEC. Only 1 patient had acute kidney injury postoperatively, and the mean length of hospital stay was 17 days. Conclusion Our study demonstrated the intraoperative physiological changes in patients undergoing open cytoreductive abdominal surgery with HIPEC. Advanced hemodynamic monitoring should be considered for better anesthetic management in these patients.