Anaesthetic management of cytoreductive surgery followed by hyperthermic intrathoracic chemotherapy perfusion

Abstract

BackgroundMacroscopic cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion (HITHOC) is a new multimodal approach for selected patients with primary and secondary pleural tumors, which may provide the patient with better local tumor control and increased overall survival rate.MethodsWe present a single-center study including 20 patients undergoing cytoreductive surgery and HITHOC between September 2008 and April 2013 at the University Medical Center Regensburg, Germany. Objective of the study was to describe the perioperative, anaesthetic management with special respect to pain and complication management.ResultsAnaesthesia during this procedure is characterized by increased intrathoracic airway and central venous pressure, hemodynamic alterations and the risk of systemic hypo- and hyperthermia. Securing an adequate intravascular volume is one of the primary goals to prevent decreased cardiac output as well as pulmonary edema. Transfusion of packed red blood cells (PRBC) was necessary in seven of 20 (35%) patients. Only two patients (10%) showed an impairment of coagulation in postoperative laboratory analysis. Perioperative forced diuresis is recommended to prevent postoperative renal insufficiency. Supplementary thoracic epidural analgesia in 13 patients (65%) showed a significant reduction of post-operative pain compared with peroral administration of opioid and non-opioid analgesics.ConclusionThis article summarizes important experiences of the anaesthesiological and intensive care management in patients undergoing HITHOC.

Effect of hyperthermic intrathoracic chemotherapy (HITHOC) on the malignant pleural effusion

“…As shown in Tables 1 and 2, total 5 articles were included in the meta-analysis (quantitative synthesis) [5–9] and 22 articles were included in the systematic review (qualitative synthesis). Among the 27 articles for systematic review and meta-analysis, 4 articles were from Japan, [5,6,10,11] 4 articles from China, [7,9,12,13] 4 articles from Italy, [14–17] 4 articles from Netherlands, [18–21] 3 articles from USA, [22–24] 3 articles from Germany, [25–27] 2 articles from Israel, [28,29] 1 from Turkey, [8] 1 from Australia, [30] and 1 from Korea. [31] The earliest was reported in 1995 by Matsuzaki et al from Japan (Matsuzaki, 1995], and the latest, up to May 2016, was from China by Liu et al [13] and from Italy by Ambrogi et al [17] …”

“…[23] They also observed a persistently high concentration of intrapleural drugs as compared to plasma concentrations when the patients were given HITHOC. [22] Similarly, Ried and coworkers [27] from Italy reported that the mean area under curves (AUCs) of cisplatin in the perfusate were approximately 55 to 58 times greater than detected in the serum, and found that elevation of the cisplatin dosage to 150 mg/m 2 did not lead to a significant increase of the systemic cisplatin concentration.…”

“…Kerscher et al [27] reported their experiences of the anesthesia and intensive care management in patients undergoing HITHOC, and they indicated that anesthesia during the procedure of CRS + HITHOC may lead to unexpected side effects including high pressure of intrathoracic and central venous system, and potential risk of systemic hyperthermia. They further reported an impairment of coagulation in postoperative laboratory analysis in 2 out of 20 patients (10%).…”

Hyperthermic intrathoracic chemotherapy after extended pleurectomy and decortication for malignant pleura mesothelioma: an observational study on outcome and microcirculatory changes

“…In this setting, the surgical stress for the patient could J Thorac Dis 2018;10(Suppl 2):S228-S236 jtd.amegroups.com [9][10][11][12][13] 9 [7][8][9][10][11][12] 11 [7][8][9][10][11][12][13][14][15] 15 [9][10][11][12][13][14][15][16][17] 13 [8][9][10][11][12][13][14][15] 11 [7- be detrimental when associated with HITHOC. For this reason it is mandatory an appropriate anaesthetic protocol associated with advanced clinical monitoring to guide and improve intraoperative and postoperative patient's management.…”

“…Recently, in a review about hyperthermic intra-peritoneal chemotherapy (HIPEC), Newton et al reported a complication rate major than 40%. The study highlights that the most common perioperative complications were respiratory and cardiovascular as well an early unset of kidney failure (11,12). Some authors showed that the intraoperative fluid management played a key role in the onset of postoperative complications after HIPEC (13).…”