Restrictive Intraoperative Fluid Therapy is Associated with Decreased Morbidity and Length of Stay Following Hyperthermic Intraperitoneal Chemoperfusion

Hendrix, Ryan J.; Damle, Aneel; Williams, Chloe H.; Harris, Ariana; Spanakis, Spiro; Lambert, Donald H.; Lambert, Laura

doi:10.1245/s10434-018-07092-y

Cited by 38 publications

(18 citation statements)

References 23 publications

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“…[4647] Restrictive fluid regimens have demonstrated decreased perioperative mortality in other major surgical procedures. [626364] However, restricted fluid therapy can cause suboptimal tissue and renal perfusion in the face of extreme haemodynamic changes that occur during the phases of CRS-HIPEC. [65] In CRS-HIPEC procedures, Colantonio et al .…”

Section: Monitoringmentioning

confidence: 99%

“…The main disadvantages of primary opioid-based analgesia are increased incidence of respiratory complications and need for postoperative ventilatory support. [64] A recent retrospective review[79] of 215 CRS-HIPEC patients showed that epidural analgesia was safe to use in terms of intraoperative and postoperative haemodynamic parameters. The median duration of epidural use is 5 days and it recommends daily check of coagulation testing until the fourth postoperative day or on clinical request.…”

Section: Pain Managementmentioning

confidence: 99%

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Society of Onco-Anaesthesia and Perioperative Care consensus guidelines for perioperative management of patients for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC)

et al. 2019

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Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for primary peritoneal malignancies or peritoneal spread of malignant neoplasm is being done at many centres worldwide. Perioperative management is challenging with varied haemodynamic and temperature instabilities, and the literature is scarce in many aspects of its perioperative management. There is a need to have coalition of the existing evidence and experts' consensus opinion for better perioperative management. The purpose of this consensus practice guideline is to provide consensus for best practice pattern based on the best available evidence by the expert committee of the Society of Onco-Anaesthesia and Perioperative Care comprising perioperative physicians for better perioperative management of patients of CRS-HIPEC.

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Section: Monitoringmentioning

confidence: 99%

Section: Pain Managementmentioning

confidence: 99%

Society of Onco-Anaesthesia and Perioperative Care consensus guidelines for perioperative management of patients for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC)

et al. 2019

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“…However, despite the benefits offered by the ERAS protocol, concerns have also been raised regarding the increased risk of readmissions and acute kidney injury (AKI) due to the stringent fluid management guideline associated with the protocol ( 14 , 15 ). While researchers have used some components of ERAS like pre-habilitation or restrictive fluid therapy for patients undergoing CRS + HIPEC ( 16 , 17 ), the impact of a comprehensive ERAS protocol on these patients is still unclear. In the past 3 years, some researchers have presented their experience of ERAS with CRS + HIPEC but with a limited sample size ( 18 , 19 ).…”

Section: Introductionmentioning

confidence: 99%

Enhanced Recovery After Surgery for Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Systematic Review and Meta-Analysis

Mao¹,

Zhenmin²

2021

Front. Surg.

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Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a promising approach for the management of peritoneal carcinomatosis, but is associated with significant morbidity and prolonged hospital stay. Herein, we review the impact of Enhanced recovery after surgery (ERAS) protocol on length of stay (LOS) and early complications in patients undergoing CRS and HIPEC for peritoneal carcinomatosis.Methods: PubMed and Embase were searched for studies comparing ERAS protocol with control for CRS + HIPEC. Mean difference (MD) and risk ratios (RR) were calculated for LOS and complications respectively.Results: Six retrospective studies were included. Meta-analysis indicated statistically significant reduction in LOS with ERAS (MD: −2.82 95% CI: −3.79, −1.85 I2 = 29% p < 0.00001). Our results demonstrated significantly reduced risk of Calvien Dindo grade III/IV complications with the use of ERAS protocol as compared to the control group (RR: 0.60 95% CI: 0.41, 0.87 I2 = 0% p = 0.007). Pooled analysis of limited studies demonstrated no statistically significant difference in the risk of reoperation (RR: 1.04 95% CI: 0.54, 2.03 I2 = 50% p = 0.90) readmission (RR: 0.55 95% CI: 0.21, 1.49 I2 = 0% p = 0.24), acute kidney injury (RR: 0.55 95% CI: 0.28, 1.10 I2 = 0% p = 0.09) or mortality (RR: 0.62 95% CI: 0.17, 2.26 I2 = 0% p = 0.46) between the study groups.Conclusion: For CRS + HIPEC, ERAS is associated with significantly reduced LOS along with lower incidence of complications. Limited data suggest that use of ERAS protocol is not associated with increased readmission, reoperation, and mortality rates in these patients. There is a need for randomized controlled trials to corroborate the current evidence.

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“…HİPEK sırasında kalp debisi, kalp hızı, end-tidal CO 2 , santral venöz basınç, intraabdominal basınç ve pulmoner arter basıncı artar ve sistemik vasküler direnç azalır, bu hemodinamik değişikliklere hipertermi eşlik edebilir. Dolayısıyla bu olgular oldukça karmaşık girişimlerdir (16,17) . Metabolik açıdan, kullanılan kemoterapötik ajana göre asidoz, hiperglisemi, hiponatremi (ör.…”

Section: Discussionunclassified

The Effect Of Intraoperative Restrictive Fluid Therapy On Postoperative Outcomes In Patients Undergoing Hyperthermic Intraperitoneal Chemotherapy

Özay¹,

Salman²,

Bölükbaşı³

et al. 2021

Jarss

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INTRODUCTION: Hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery (CRC) are effective multimodal treatment options in patients with peritoneal carcinomatosis. Procedures are long-lasting operations with excessive blood and fluid loss. Intraoperative fluid management is very important because of major hemodynamic, respiratory and metabolic changes. This study aims to investigate the effect of intraoperative restrictive fluid therapy on postoperative outcome in patients undergoing HIPEC and SRS. METHODS: Patients who underwent HIPEC and SRS in our clinic between 2014-2018 were included in the study. The demographic, intraoperative and postoperative data of all patients were retrospectively analyzed. The patients who underwent restrictive fluid replacement were named Group R, and the group with liberal fluid replacement was named Group L. RESULTS: It was observed that the mean age was 54.6 ± 11.4 years, the female gender was 60.5% and the malignancy originating from the gastrointestinal system was 76.3%. There was no effect of liberal and restrictive fluid treatments on postoperative minor and major complications, length of stay in hospital and intensive care, and mortality. DISCUSSION AND CONCLUSION: We concluded that intraoperative restrictive fluid therapy did not affect postoperative complications and mortality in HIPEC and SRS surgeries.

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Restrictive Intraoperative Fluid Therapy is Associated with Decreased Morbidity and Length of Stay Following Hyperthermic Intraperitoneal Chemoperfusion

Cited by 38 publications

References 23 publications

Society of Onco-Anaesthesia and Perioperative Care consensus guidelines for perioperative management of patients for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC)

Society of Onco-Anaesthesia and Perioperative Care consensus guidelines for perioperative management of patients for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC)

Enhanced Recovery After Surgery for Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Systematic Review and Meta-Analysis

The Effect Of Intraoperative Restrictive Fluid Therapy On Postoperative Outcomes In Patients Undergoing Hyperthermic Intraperitoneal Chemotherapy

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