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. 2019 Oct;63(10):805-813.
doi: 10.4103/ija.IJA_324_19. Epub 2019 Oct 10.

Perioperative management and postoperative outcome of patients undergoing cytoreduction surgery with hyperthermic intraperitoneal chemotherapy

Hamed Elgendy  1   2   3 , Hanaa Nafady-Hego  4   5 , Hanan M Abd Elmoneim  6   7 , Talha Youssef  8 , Abdulaziz Alzahrani  9
Affiliations

Perioperative management and postoperative outcome of patients undergoing cytoreduction surgery with hyperthermic intraperitoneal chemotherapy

Hamed Elgendy et al. Indian J Anaesth. 2019 Oct.

Abstract

Background and aims: The existence of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) as a multidisciplinary approach for peritoneal cancer gains acceptance in many countries including Saudi Arabia. The aim of our study is to describe the perioperative management of patients who received CRS/HIPEC and to report their outcomes and complications at our tertiary centre.

Methods: The preoperative characteristics, surgical variables, perioperative management, postoperative course and outcomes of 38 CRS/HIPEC patients were prospectively collected and analysed.

Results: The mean age of our patients was 52 years, and 23 (60.5%) of them were females. The overall postoperative mortality was 42.1%. Univariate analyses of risk factors for deaths after HIPEC demonstrated that low preoperative (haemoglobin, potassium, calcium and albumin), high (tumour marker (CA19.9), intraoperative transfusion of human plasma protein (HPP), colloids, postoperative activated partial thromboplastin time and bacterial infections were potential risk factors for patient's mortality. Multivariate analysis of those variables demonstrated that low preoperative calcium [hazard ratio (HR) = 0.116; 95% confidence interval (CI) = 0.033-0.407; P = 0.001], high intraoperative HPP transfusion (HR = 1.004; 95% CI = 1.001-1.003; P = 0.012) and presence of postoperative bacterial infection (HR = 5.987; 95% CI = 1.009-35.54; P = 0.049) were independent predictors of patient's death. Seventy morbidities happened after HIPEC; only bacterial infection independently predicted postoperative mortality.

Conclusion: To improve postoperative outcome of CRS/HIPEC, optimisation of transfusion, temperature, electrolytes and using broader-spectrum prophylaxis to manage postoperative infections should be warranted.

Keywords: Cytoreductive surgery; hyperthermic intraperitoneal chemotherapy; morbidity; mortality.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a) Survival curve for patients after hyperthermic intraperitoneal chemotherapy (HIPEC) procedure. (b) Types and site of pathogens isolated from non-survivors. The most commonest site for infection was surgical site infection (SSI) followed by blood stream infection (BSI), urinary tract infection (UTI), then respiratory tract infection (RTI), ESBL: Extended-spectrum beta-lactamases; VRE: Vancomycin-resistant enterococci
Figure 2
Figure 2
Haemodynamic variables during HIPEC procedure. Includes invasive systolic, diastolic blood pressures (mmHg), heart rate (beats/min) and central venous pressure (mmHg) changes during HIPEC procedure
Figure 3
Figure 3
Acid–base, potential of hydrogen (pH), bicarbonate ion (mmol/L), lactate (mmol/L); glucose (mmol/L); temperature (C°) changes during HIPEC procedure
See this image and copyright information in PMC

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