Intensive Care Unit Admission after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Is It Necessary?

López-Basave, Horacio Noé; Morales-Vásquez, Flavia; Méndez-Herrera, Carmen; Ñamendys‐Silva, Silvio A.; Luna-Ortiz, Kuauhyama; Calderillo-Ruiz, G.; Rojas, Jesús Cabrera; Ruiz‐García, Erika; Herrera‐Gómez, Ángel; Ruiz-Molina, Juan Manuel; García, Abelardo Meneses

doi:10.1155/2014/307317

Cited by 13 publications

(10 citation statements)

References 31 publications

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“…Previous studies reported a higher percentage (67%-100%) of patients admitted to the ICU postoperatively[22,28,29]. The mean ICU LOS in this patient population was also similar to the previous studies (≤ 5 d)[6,29].…”

Section: Discussionsupporting

confidence: 88%

Critical care management and intensive care unit outcomes following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

Kapoor

Bassily‐Marcus

Yunen

et al. 2017

WJCCM

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AIMTo study the early postoperative intensive care unit (ICU) management and complications in the first 2 wk of patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).METHODSOur study is a retrospective, observational study performed at Icahn School of Medicine at Mount Sinai, quaternary care hospital in New York City. All adult patients who underwent CRS and HIPEC between January 1, 2007 and December 31, 2012 and admitted to ICU postoperatively were studied. Fifty-one patients came to the ICU postoperatively out of 170 who underwent CRS and HIPEC therapy during the study period. Data analysis was performed using descriptive statistics.RESULTSOf the 170 patients who underwent CRS and HIPEC therapy, 51 (30%) came to the ICU postoperatively. Mean ICU length of stay was 4 d (range 1-60 d) and mean APACHE II score was 15 (range 7-23). Thirty-one/fifty-one (62%) patients developed postoperative complications. Aggressive intraoperative and postoperative fluid resuscitation is required in most patients. Hypovolemia was seen in all patients and median amount of fluids required in the first 48 h was 6 L (range 1-14 L). Thirteen patients (25%) developed postoperative hypotension with seven requiring vasopressor support. The major cause of sepsis was intraabdominal, with 8 (15%) developing anastomotic leaks and 5 (10%) developing intraabdominal abscess. The median survival was 14 mo with 30 d mortality of 4% (2/51) and 90 d mortality of 16% (8/51). One year survival was 56.4% (28/51). Preoperative medical co morbidities, extent of surgical debulking, intraoperative blood losses, amount of intra op blood products required and total operative time are the factors to be considered while deciding ICU vs non ICU admission.CONCLUSIONOverall, ICU outcomes of this study population are excellent. Triage of these patients should consider preoperative and intraoperative factors. Intensivists should be vigilant to aggressive postop fluid resuscitation, pain control and early detection and management of surgical complications.

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Section: Discussionsupporting

confidence: 88%

Critical care management and intensive care unit outcomes following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

Kapoor

Bassily‐Marcus

Yunen

et al. 2017

WJCCM

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“…However, it was recently reported that there was no difference in the rate and degree of complications observed in patients who were admitted in the ICU, noting that ICU admission should not be standardized, but based on individual patient characteristics. [22] Intraoperative parameters may be associated with postoperative outcome, in terms of morbidity and mortality, as demonstrated by a previous study conducted by our team. [23] 4.3 Lactate as a marker of perioperative and long -term outcome…”

Section: Lactate Physiology and Hyperlactaemiamentioning

confidence: 60%

Serum lactate as predictor of morbidity, mortality and long term survival in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Spiliotis

Halkia

Zouridis

et al. 2015

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Introduction: Serum lactate elevation has been used as a marker of tissue hypoxia in the setting of perioperative monitoring and critical care. It has also been correlated with perioperative morbidity and mortality. Cytoreductive surgery (CRS) & hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of peritoneal carcinomatosis is a major abdominal operation, requiring meticulous perioperative care. The aim of this study is to assess the clinical use of lactate measurements after CRS & HIPEC and its prognostic value in terms of immediate postoperative morbidity and mortality, as well as long term survival. Material & Methods: Of 140 patients diagnosed with peritoneal carcinomatosis who underwent cytoreductive surgery and HIPEC were prospectively studied. Serum lactate was measured by air blood gases analyser intraoperatively (just before the administration of HIPEC) and then daily till the fifth postoperative day. Postoperative complications were recorded and divided into two groups according to Clavien Dindo classification. Results: Intraoperative lactate measurements have not been associated with postoperative morbidity and mortality. On the other hand, lactate measurements on postoperative days 3 and 4 are of clinical significance. Specifically, an increase of 1 mmol/L of the average lactate value of days 3 and 4 raises the risk of a minor complication (Grades I to IIIa) by 1.9, the risk of a major complication (Grades IIIb to V) by 10.9 and the risk of mortality by 32.1%. Conclusions: The average of day 3 and 4 postoperative day lactate level is an independent predictor of morbidity and mortality in patients undergoing CRS and HIPEC.

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“…However, it was recently reported that there was no difference in the rate and degree of complications observed in patients who were admitted to the ICU, noting that ICU admission should not be standardized but should be based on individual patient characteristics [8]. …”

Section: Discussionmentioning

confidence: 99%

Peritoneal Carcinomatosis: Intraoperative Parameters in Open (Coliseum) versus Closed Abdomen Hipec

Halkia

Tsochrinis

Vassiliadou

et al. 2015

International Journal of Surgical Oncology

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Background. Peritoneal carcinomatosis (PC) is associated with a poor prognosis. Cytoreductive surgery (CRS) and HIPEC play an important role in well-selected patients with PC. The aim of the study is to present the differences in the intraoperative parameters in patients who received HIPEC in two different manners, open versus closed abdomen. Patients and Methods. The population includes 105 patients with peritoneal carcinomatosis from colorectal, gastric, and ovarian cancer, sarcoma, mesothelioma, and pseudomyxoma peritonei. Group A (n = 60) received HIPEC using the open technique and Group B (n = 45) received HIPEC with the closed technique. The main end points were morbidity, mortality, and overall hospital stay. Results. There were two postoperative deaths (3.3%) in the open group versus no deaths in the closed group. Twenty-two patients in the open group (55%) had grade III-IV complications versus 18 patients in the closed group (40%). There are more stable intraoperative conditions in the closed abdomen HIPEC in CVP, pulse rate, and systolic pressure parameters. Conclusions. Both methods are equal in the HIPEC procedures. Perhaps the closed method is the method of choice for frail patients due to more stable hemodynamic parameters.

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Intensive Care Unit Admission after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Is It Necessary?

Cited by 13 publications

References 31 publications

Critical care management and intensive care unit outcomes following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

Critical care management and intensive care unit outcomes following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

Serum lactate as predictor of morbidity, mortality and long term survival in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Peritoneal Carcinomatosis: Intraoperative Parameters in Open (Coliseum) versus Closed Abdomen Hipec

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