Evaluation of the relationship between lactacidemia and postoperative complications after surgery for peritoneal carcinomatosis

Abstract

Background: Cytoreductive surgery was developed as a treatment for peritoneal carcinomatosis. However, this surgery is associated with important complications. The present study aimed to assess the relationship between lactacidemia and the rate of associated complications during the immediate postoperative period in the intensive care unit (ICU) in patients undergoing cytoreductive surgery.

Methods: This was a retrospective observational study. A total of 57 patients underwent cytoreductive surgery. All patients were admitted to the ICU immediately after the surgery. Data on lactic acid levels at the time of admission and discharge from the ICU were collected. Postsurgical complications that occurred during the ICU stay were recorded according to failure-to-rescue analysis and their severity stratified according to the Clavien-Dindo classification.

Results: The lactic acid levels at admission to the ICU were significantly higher in patients who developed complications, with an almost tripled unadjusted relative risk (2.9, 95% CI: 1.6, 5.3), than in those who did not develop complications for the lactacidemia threshold established in the cumulative sum curve graphs. After adjustment for confounding effects, the relative risk became even higher (3.1, 95% CI: 1.8, 3.6). Lactic acid levels were still significantly higher in this group at the time of discharge from the ICU.

Conclusions: Serum lactate level is a risk factor for postoperative complications in patients undergoing cytoreductive surgery for peritoneal carcinomatosis. This study suggests that the risk of developing severe complications almost triples with a lactic acid level of 2.5 mmol/L or higher at the time of admission in the ICU.

Keywords: Cytoreduction surgical procedures; Intensive care units; Lactic acid; Mortality; Peritoneal neoplasms; Postoperative complications.

Fig. 1.

Level of lactic acid in the group of patients who developed complications in the intensive care unit (ICU).

Fig. 2.

Level of lactic acid in the group of patients who did not develop complications in the intensive care unit (ICU).

Fig. 3.

Cumulative sum curve (CUSUM) for complications. The arrow points to the most discriminating cutoff point of lactic acid level with respect to the presence of complications from each value of lactic acid level. ICU: intensive care unit.

Fig. 4.

Cumulative sum curve (CUSUM) for death. The arrow points to the most discriminating cutoff point of lactic acid level with respect to death from each value of lactic acid level. ICU: intensive care unit.