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

Abstract

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.

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

“…These studies indicate that not only the increase in lactate levels has been associated with postoperative morbidity and mortality, but also the time until normalization of the levels. The relationship between lactic acid elevation and post-surgical morbidity in cytoreductive surgery has also been shown by Spiliotis et al [6] in a study on patients with cytoreductive surgery and HIPEC.…”

“…Its production is increased under hypoperfusion or stress conditions, causing an increase in glycolysis [ 12 – 14 ]. Although lactate levels may be elevated in several conditions, it has been effectively used as a measure of tissue hypoxia [ 1 , 6 , 15 ]. However, this is not uniformly accepted, as the level may increase under other conditions [ 13 , 14 , 16 , 17 ].…”

“…It has been shown that elevated levels of lactacidemia are correlated with tissue hypoxia and predict an increase in perioperative morbidity and mortality [6,7].…”

“…Elevated levels of lactic acid (lactacidemia) has been shown to be correlated with tissue hypoxia and to predict increased perioperative morbidity and mortality [ 6 , 7 ]. According to Spiliotis et al the average of 3 and 4 postoperative day lactate level is an independent predictor of morbidity and mortality in patients undergoing CRS and HIPEC.…”

The association of early postoperative lactate levels with morbidity after elective major abdominal surgery

“…Hyperlactatemia following major surgery has been observed in many studies [15][16][17][18][19]. It is usually attributed to an oxygen debt, resulting from a tissue hypoxia [20].…”