Treatment of hypermyoglobinemia after CRS + HIPEC for patients with peritoneal carcinomatosis: A retrospective comparative study

Abstract

This retrospective comparative study aims to explore the time courses of serum myoglobin (Mb) changes, and summarize our experience in treating patients with hypermyoglobinemia after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).This study covered 60 patients with peritoneal carcinomatosis treated with CRS + HIPEC as the study group, and another 25 cancer patients treated with conventional extensive surgery without HIPEC as the control group from February to October 2016. In the study group, patients with postoperative hypermyoglobinemia were on a comprehensive treatment regimen consisting intravenous injection of sodium bicarbonate solution according to the Mb level. In the control group, patients were recorded and treated with the same regimen except for special sodium bicarbonate solution. The preoperative and postoperative serum Mb, blood urine nitrogen (BUN), and creatinine (Cr) levels were evaluated.There were no significantly difference between the 2 groups in serum Mb, BUN, and Cr levels before surgery. Postoperative serum Mb levels were elevated in both groups and significantly higher on postoperative 0 to 2 days (P < .05) in the study group than the control group. The peak value of serum Mb levels (426.65 ± 108.386 μg/L) occurred on the surgery day. The serum Mb change rate was much bigger in the study group than the control group. Serum BUN levels in both groups revealed a slow increase during the early postoperative period and were significantly lower in the study group than the control group on days 1 and 2. The serum Cr levels were similar and stable between the 2 groups after surgery. The serum Cr change rates changed synchronously with same tendency in both groups, and on postoperative day 1 the increase rate was bigger in the control group than the study group.Hypermyoglobinemia is a common and prominent lab abnormality after CRS + HIPEC, and serum Mb levels could be an early and sensitive indicator for dramatic disturbances in the internal milieu after CRS + HIPEC. Adequate treatment with sodium bicarbonate could accelerate the reduction in serum Mb levels and reduce the risk for major organ damages.

Figure 1

Comparison in perioperative serum Mb levels between the study group and the control group. Serum Mb levels were similar between the 2 groups before surgery (day −1). Immediately after surgery, the study group had significantly higher serum Mb levels than the control groups for 3 days (days 0, 1, and 2). On postoperative days 3 and 4, there were no significant differences in serum Mb levels between the 2 groups.

Figure 2

Serum Mb level changes in the study group and the control group. (A) The serum Mb curves showed that the study group had much bigger increases and decreases than the control group. (B) In terms of serum Mb change rates, at each time point, the serum Mb change rates were much bigger in the study group than the control group.

Figure 3

Comparison in perioperative serum BUN levels between the study group and the control group. Serum BUN levels were similar between the 2 groups before surgery (day −1) and surgery day (day 0). After surgery, the study group had significantly lower serum BUN levels than the control groups for 2 days (days 1 and 2). On postoperative days 3 and 4, there were no significant differences in serum BUN levels between the 2 groups. BUN = blood urine nitrogen.

Figure 4

Serum BUN level changes in the study group and the control group. (A) The serum BUN curves showed that both groups had a slow increase during the early postoperative period. (B) In terms of serum BUN change rates, at each time point, the serum BUN change rates increased synchronously but decreased slowly in the study group than the control group after surgery. BUN = blood urine nitrogen.

Figure 5

Comparison in perioperative serum Cr levels between the study group and the control group. Serum Cr levels were similar between the 2 groups before surgery (day −1) and postoperation days (days 0–4).

Figure 6

Serum Cr level changes in the study group and the control group. (A) The serum Cr curves showed that both groups had a similar and stable serum Cr levels during the perioperative period. (B) In terms of serum Cr change rates, at each time point, the serum Cr change rates changed synchronously with same tendency in both groups.