Perioperative management of patients with cytoreductive surgery for peritoneal carcinomatosis

Schmidt, Carl; Moritz, Stefan; Rath, Suryasnata; Grossmann, Erik M.; Wiesenack, Christoph; Piso, P.; Graf, B.M.; Bucher, Michael

doi:10.1002/jso.21322

Cited by 54 publications

(66 citation statements)

References 33 publications

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“…The complexity of intraoperative fluid management and their components for major surgeries has recently been described, and an individual demand oriented strategy has been suggested in the general surgical adult population [13,14]. However, most reports on intraoperative fluid management for peritoneal surface malignancy surgery emphasize the importance of liberal fluid administration to maintain adequate organ perfusion [1,2,4,5]. Some authors in this specific area of oncologic surgery have begun to explore a goal directed approach to intra-and perioperative fluid administration following flow derived perfusion parameters to facilitate perioperative patient management and improve outcomes [2].…”

Section: Discussionmentioning

confidence: 99%

“…However, most reports on intraoperative fluid management for peritoneal surface malignancy surgery emphasize the importance of liberal fluid administration to maintain adequate organ perfusion [1,2,4,5]. Some authors in this specific area of oncologic surgery have begun to explore a goal directed approach to intra-and perioperative fluid administration following flow derived perfusion parameters to facilitate perioperative patient management and improve outcomes [2]. In our cohort, fluid replacement was extensive with a mean cumulative amount of 12866 ml, very similar to that described by Miao et al [5].…”

Section: Discussionmentioning

confidence: 99%

“…The physiologic demands on patients undergoing these often prolonged procedures, and subsequently the intra-and postoperative management challenges to the perioperative care team have been well described [1][2][3]. Appropriate and liberal fluid management to maintain adequate organ perfusion has been advocated for CRS and HIPEC, but poorly defined [2,4,5].…”

Section: Introductionmentioning

confidence: 99%

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Impact of Intraoperative Anesthetic and Fluid Management on 30-day Postoperative Outcomes in a Newly Established Surgical Peritoneal Surface Malignancy Program

Schumann¹

2012

J Anesthe Clinic Res

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Background: Anesthetic and fluid management during cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) may influence 30-day postoperative outcomes. We investigated intraoperative management differences and their relation to outcomes in all consecutive patients undergoing HIPEC and CRS following the first 2 years after initiation of this surgical oncology program in a single center. Methods:Following IRB approval we retrospectively recorded demographics, intraoperative anesthetic and fluid management and 30-day postoperative cardiopulmonary, renal, infectious, neurologic, and surgical complications, mortality and length-of-stay in patients undergoing CRS and HIPEC. The Chi-square, Fisher's exact and Wilcoxon two-sample tests were used for statistics. A p < 0.05 was significant. Results:We identified 34 patients with a mean age of 53.9 ± 11.5 years. Postoperative complications occurred in 14 patients (41%), twelve of whom (35%) had pulmonary adverse events. Patients with complications were significantly older (p=0.04) and were significantly longer hospitalized (p=0.00). Neither primary malignancy type nor intraoperative fluid replacement differed between groups. Patients with complications had mild preoperative anemia (p=0.052). Conclusions:In this initial single center experience with CRS and HIPEC, patients experienced liberal intraoperative fluid replacement, a high postoperative complication rate, but no 30-day mortality. Patients with postoperative complications were significantly older, while intraoperative anesthetic and fluid management were not different between groups. Preoperative anemia in patients developing postoperative complications deserves prospective study. A steep learning curve in patient selecion and intraoperative management was observed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of Intraoperative Anesthetic and Fluid Management on 30-day Postoperative Outcomes in a Newly Established Surgical Peritoneal Surface Malignancy Program

Schumann¹

2012

J Anesthe Clinic Res

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“…Sitoredüktif cerrahi nedeniyle oluşan inflamatuvar cevap üçüncü boşluklara sıvı kaçışını daha da artırır (20,21). Chi ve ark.…”

Section: Discussionunclassified

Evre III–IV Over Kanseri Nedeniyle Sitoredüktif Cerrahi Geçiren Hastalarda Postoperatif Yoğun Bakım Gereksiniminin Ön Belirleyicileri

Kaplan¹,

Araz²,

Candan³

et al. 2012

Tybbd

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ÖZET Amaç: Over kanseri hastalarında preoperatif ve intraoperatif verilerin postoperatif yoğun bakım (YB) ihtiyacının tahmininde kullanılabileceğinin gösterilmesi. Gereç ve Yöntem: Çalışmamızda Ocak 2007-Aralık 2009 tarihleri arasında sitoredüktif cerrahi uygulanan tüm hastaların verileri geriye dönük olarak tarandı. Demografik özellikler, eşlik eden hastalıklar, operasyon öncesi laboratuvar bulguları, operasyon sırasındaki veriler ve operasyon sonrası YB'a kabulü/kabul edilmeyişine dair veriler kaydedildi. Bulgular: Çalışmamızda ilerlemiş over kanseri nedeniyle sitoredüktif cerrahi uygulanan 122 hastadan 58'inin (%48) operasyon sonrası YB'a kabul edildiği görüldü. Yoğun bakıma alınmayan grupla karşılaştırıldığında YB'a kabul edilen hastalarda; kronik obstrüktif akciğer hastalığı, intraoperatif hipotansiyon ve taşikardi, kan ürünleri transfüzyonu ihtiyacı daha sıktı, yaşları, ortalama vücut kitle indeksleri daha yüksekti. Operasyon öncesi daha düşük bir oksijen satürasyonuna sahiptiler ve intraoperatif daha fazla sıvı verilmesi gerekti. İkili lojistik regresyon analizi bu hastalarda; yaş (OR, 1,1; p=0,036), ASA skoru (OR, 6,2; p=0,044), intraoperatif sinüs taşikardisi olması (OR,8,6; p=0,013), operasyon sırasında transfüzyon gerekliliği (OR, 7,7; p=0,026) ve preoperatif oksijen satürasyonunun (OR, 1,3; p=0,050), YB'a kabul edilmenin ön belirleyicileri olduğunu gösterdi. Sonuç: Bulgular göstermektedir ki, ileri yaş, yüksek ASA sınıfı ve preoperatif düşük oksijen satürasyonu ile intraoperatif sinüs taşikardisi gelişmesi ve kan ve kan ürünü transfüzyonu yapılması bu hasta grubunda postoperatif yoğun bakım ihtiyacı için bağımsız risk faktörleridir. Anah tar Ke li me ler: Over kanseri, yoğun bakım, ön belirleyicilerSUMMARY Objective: To demonstrate that preoperative and intraoperative data of ovarian carcinoma patients can be used for prediction of postoperative ICU admission. Material and Method: The charts of all patients with ovarian carcinoma who underwent cytoreductive surgery from January 2007 to December 2009 were reviewed. The data recorded were demographic features, coexisting disease, preoperative laboratory findings, intraoperative data, and admission/no admission to ICU postoperatively. Results: Out of 122 patients who underwent cytoreductive surgery for advanced ovarian carcinoma, 58 patients (48%) required ICU admission postoperatively. Compared with the group not admitted to ICU, the patients with ICU admission were significantly different regarding the frequency of chronic obstructive pulmonary disease, occurrence of intraoperative hypotension and sinus tachycardia, intraoperative need for blood products and total fluid transfusion, preoperative oxygen saturation, mean age and mean body mass index (BMI). Binary logistic regression analysis revealed that age (OR, 1.1; p=0.036), ASA score (OR, 6.2; p=0.044), occurrence of intraoperative sinus tachycardia (OR, 8.6; p=0.013), need for intraoperative transfusions (OR, 7.7; p=0.026) and preoperative oxygen saturations (OR, 1.3; p=0.050) were the predictors ...

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“…Continuous monitoring of the core body temperature (nasopharynx/oesophagus) and the abdominal cavity temperature during HIPEC are mandatory. Thermoregulation plays a significant role in maintaining the metabolic homeostasis, coagulation, anti-inflammatory cascade and neurological status intact [17].…”

Section: Perioperative Thermoregulationmentioning

confidence: 99%

Anaesthetic Considerations in the Perioperative Management of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Sheshadri

Chakravarthy

2016

Indian J Surg Oncol

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Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy has emerged as one of the primary modalities of treatment of diffuse peritoneal malignancies. It is a complex surgical procedure with the patients facing major and potentially life threatening alterations of haemodynamic, respiratory, metabolic and thermal balance with significant fluid losses and the perioperative management is challenging for anaesthesiologists and intensive care physicians. Though the alterations are short lived, these patients require advanced organ function monitoring and support perioperatively. The anaesthesiologist is involved in the management of haemodynamics, respiratory function, coagulation, haematologic parameters, fluid balance, thermal variations, and metabolic and nutritional support perioperatively. The chemotherapy instillate used are known to cause nephrotoxicity, cardiotoxicity, dyselectrolytemia and lactic acidosis. The preoperative polypharmacy for pain control, previous surgery and/or chemotherapy, malnourished status secondary to feeding problems and tumour wasting syndrome make the task all the more challenging. The anaesthesiologist also needs to consider the perioperative care from a quality of life perspective and proper preoperative counselling is important. The present overview summarizes the challenges faced by the anaesthesiologist regarding the pathophysiological alterations during the Cytoreductive surgery and Hyperthermic intraperitoneal chemotherapy in the preoperative, intraoperative and postoperative periods.

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Perioperative management of patients with cytoreductive surgery for peritoneal carcinomatosis

Cited by 54 publications

References 33 publications

Impact of Intraoperative Anesthetic and Fluid Management on 30-day Postoperative Outcomes in a Newly Established Surgical Peritoneal Surface Malignancy Program

Impact of Intraoperative Anesthetic and Fluid Management on 30-day Postoperative Outcomes in a Newly Established Surgical Peritoneal Surface Malignancy Program

Evre III–IV Over Kanseri Nedeniyle Sitoredüktif Cerrahi Geçiren Hastalarda Postoperatif Yoğun Bakım Gereksiniminin Ön Belirleyicileri

Anaesthetic Considerations in the Perioperative Management of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

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