Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan 17;408(1):34.
doi: 10.1007/s00423-023-02770-2.

Intraoperative metabolic changes associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Jesús David Rubio-López  1 , Manuel Durán-Martínez  2 , Andrea Moreno-Blázquez  3 , Lidia Rodríguez-Ortiz  4   3 , Blanca Rufián-Andújar  4 , Francisca Valenzuela-Molina  4 , Ángela Casado Adam  4   3 , Juan M Sánchez-Hidalgo  4   3 , Sebastián Rufián-Peña  4   3 , Antonio Romero-Ruiz  3 , J Briceño-Delgado  4 , Álvaro Arjona-Sánchez  5   6
Affiliations

Intraoperative metabolic changes associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Jesús David Rubio-López et al. Langenbecks Arch Surg. .

Erratum in

Abstract

Background: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) causes considerable hemodynamic, respiratory, and metabolic changes during the perioperative period.

Objectives: To evaluate metabolic changes associated with this procedure. Understanding perioperative factors and their association with morbidity may improve the perioperative management of patients undergoing this treatment.

Methods: A retrospective review of a prospectively maintained database was performed. All consecutive unselected patients who underwent CRS plus HIPEC between January 2018 and December 2020 (n = 219) were included.

Results: The mean age was 58 ± 11.7 years and 167 (76.3%) were female. The most frequent histology diagnosis was serous ovarian carcinoma 49.3% (n = 108) and colon carcinoma 36.1% (n = 79). Mean peritoneal cancer index was 14.07 ± 10.47. There were significant variations in pH, lactic acid, sodium, potassium, glycemia, bicarbonate, excess bases, and temperature (p < 0.05) between the pre-HIPEC and post-HIPEC periods. The closed HIPEC technique resulted in higher levels of temperature than the open technique (p < 0.05). Age, potassium level post-HIPEC potassium level, and pre-HIPEC glycemia were identified as prognostic factors for morbidity in multivariate analysis.

Conclusion: The administration of HIPEC after CRS causes significant changes in internal homeostasis. Although the closed technique causes a greater increase in temperature, it is not related to higher morbidity rates. The patient's age, post-HIPEC potassium level, and pre-HIPEC glycemia are predictive factors for morbidity.

Keywords: Anesthesia; HIPEC; Perioperative management; Peritoneal carcinomatosis.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Comparative graph of means and standard deviation of metabolic parameters and temperature before HIPEC versus after HIPEC. A pH pre-HIPEC (7.34 ± 0.06) and post-HIPEC (7.32 ± 0.079 (p < 0.05). B Lactic acid (mmol/L) pre-HIPEC (1.68 ± 1.24) and post-HIPEC (3.72 ± 1.94) (p < 0.05). C Sodium (mEq/L) pre-HIPEC (138.08 ± 2.72) and post-HIPEC (137.68 ± 3.02) (p < 0.05). D Potassium (mEq/L) pre-HIPEC (3.57 ± 0.5) and post-HIPEC (3.28 ± 0.42) (p < 0.05). E Glycemia (mg/dL) pre-HIPEC (149.4 ± 44.79) and post-HIPEC (227.5 ± 50.16) (p < 0.05). F Bicarbonate (mmol/L) pre-HIPEC (23.25 ± 2.75) and post-HIPEC (21.3 ± 2.94) (p < 0.05). G Bases excess (mEq/L) pre-HIPEC (− 2.42 ±  − 3.10) and post-HIPEC (− 4.49 ± 3.49) (p < 0.05). H Temperature (°C) pre-HIPEC (35.47 ± 0.83) and post-HIPEC (37.80 ± 0.79) (p < 0.05)
Fig. 2
Fig. 2
ROC curve for early complications. Area under the ROC curve = 0.718 (95% CI = 0.624 to 0.811). We observed that in almost 72% of all possible pairs of subjects in which one has early major complications and the other does not, the model will assign a higher probability to the subject with early major complications. The resulting logistic equation is Z = logit (p) =  − 9.780 + age * 0.045 + 1.238 * potassium_posHIPEC + 0.012 * glycemia_preHIPEC
See this image and copyright information in PMC

References

    1. Sadeghi B, Arvieux C, Glehen O, et al. Peritoneal carcinomatosis from non-gynecologic malignancies. results of the EVOCAPE 1 Multicentric Prospective Study. Cancer. 2000;88:358–63. doi: 10.1002/(SICI)1097-0142(20000115)88:2<358::AID-CNCR16>3.0.CO;2-O. - DOI - PubMed
    1. Sugarbaker PH. Peritonectomy procedure. Ann Surg. 1995;221:29–42. doi: 10.1097/00000658-199501000-00004. - DOI - PMC - PubMed
    1. Sugarbaker PH, Cunliffe W, Belliveau JF, DeBruijn EA, Graves T, Mullins R, et al. Rationale for perioperative intraperitoneal chemotherapy as a surgical adjuvant for gastrointestinal malignancy. Reg Cancer Treat. 1988;1:66–79.
    1. Spratt JS, Adcock RA, Muskovin M, Sherrill W, McKeown J. Clinical delivery system for intraperitoneal hyperthermic chemotherapy. Cancer Res. 1980;40:256–260. - PubMed
    1. Cochrane Database Syst. Rev. Intraperitoneal chemotherapy for the initial management of primary epithelial ovarian cancer. Cochrane Database Syst Rev (11): CD005340. 10.1002/14651858.CD005340.pub3.