Physiologic and hemodynamic changes in patients undergoing open abdominal cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

Abstract

Objective We aimed to determine the physiological and hemodynamic changes in patients who were undergoing hyperthermic intraperitoneal chemotherapy (HIPEC) cytoreductive surgeries. Methods This prospective, observational study enrolled 21 patients who were undergoing elective cytoreductive surgery with HIPEC at our hospital over 2 years. We collected vital signs, hemodynamic parameters including global end-diastolic volume index (GEVI) and extravascular lung water index (ELWI) using the VolumeView™ system, and arterial blood gas analysis from all patients. Data were recorded before skin incision (T1); 30 minutes before HIPEC initiation (T2); 30 (T3), 60 (T4), and 90 (T5) minutes after HIPEC initiation; 30 minutes after HIPEC completion (T6); and 10 minutes before surgery completion (T7). Results Patients showed an increase in body temperature and cardiac index and a decrease in the systemic vascular resistance index. GEDI was 715.4 (T1) to 809.7 (T6), and ELWI was 6.9 (T1) to 7.3 (T5). Conclusions HIPEC increased patients’ body temperature and cardiac output and decreased systemic vascular resistance. Although parameters that were extracted from the VolumeView™ system were within their normal ranges, transpulmonary thermodilution approach is helpful in intraoperative hemodynamic management during open abdominal cytoreductive surgery with HIPEC. Trial registry name: ClinicalTrials.gov Trial registration number: NCT02325648 URL: https://clinicaltrials.gov/ct2/results?cond=NCT02325648&term

Changes in Coagulation in Cancer Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy Treatment (HIPEC)—A Systematic Review

“…Fifteen studies with a total of 1,445 patients were included in the qualitative synthesis presented in ►Table 1. 15,24,[35][36][37][38][39][40][41][42][43][44][45][46][47]…”

“…15,24,[35][36][37][38][39][40][41][42][43][44][45][46][47] Out of 15 studies, 13 studies reported primary tumor location (93%). 15,24,[35][36][37][38][39][40][41][42][43][44][45][46] Neoadjuvant chemotherapy was administered in two studies. 7,24…”

“…15,24,[36][37][38][39]41,[43][44][45] Length of surgery was reported from 240 to 1,080 minutes in 13 studies. 15,24,[35][36][37][38][39]41,[43][44][45][46][47] The HIPEC method was reported in 13 out of 15 studies. 15,24,35,36,[38][39][40][41][43][44][45][46][47] Six studies used the open abdomen method, 24,35,[38][39][40]44,45 four used the closed abdomen method, 41,43,46,47 and two used both methods for HIPEC.…”

Reliability of bioreactance and pulse power analysis in measuring cardiac index during cytoreductive abdominal surgery with hyperthermic intraperitoneal chemotherapy (HIPEC)

“…There are a lot of hemodynamic changes during HIPEC due to increased temperature, such as increased heart rate, increased CI , increased oxygen consumption and decreased systemic vascular resistance [ 24 ]. Bleeding results in hypovolemia, as well as the major surgical resections, physicochemical trauma and HIPEC by altering the capillary permeability [ 2 , 24 ]. While optimal fluid therapy often necessitates aggressive fluid resuscitation, avoiding fluid overdose is important [ 2 ].…”

Administration of Low-Dose Dexmedetomidine Did Not Affect Acute Inflammatory Response after Cytoreductive Surgery Combined with Hyperthermic Intraperitoneal Chemotherapy: A Double-Blind Randomized Controlled Trial

“…A continuous infusion of a vasopressor, phenylephrine or norepinephrine, was administered to maintain the mean arterial pressure (MAP) and HR within 20% of the basal preoperative value. Hydroxyethyl starch (6% 130/0.4) in a balanced electrolyte solution (Volulyte ® , Fresenius Kabi AG, Bad Homburg, Germany) was used for perioperative fluid management accompanied by crystalloid infusion [ 19 ]. The body temperature was monitored continuously using an esophageal probe, and a Bair Hugger™ upper body airstream blanket (3M Deutschland GmbH, Neuss, Germany) with a forced-air warmer, hot IV line, and heated circuit was applied for warming during the CRS phase.…”