Standard Operating Procedures for Anesthesia Management in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Improve Patient Outcomes: A Patient Cohort Analysis

Fichmann, Dominique; Roth, Lilian; Raptis, Dimitri A.; Kajdi, Marie-Elisabeth; Gertsch, Philippe; Vonlanthen, René; Rougemont, Olivier de; Moral, Julio; Beck‐Schimmer, Beatrice; Lehmann, Kuno

doi:10.1245/s10434-019-07644-w

Cited by 11 publications

(7 citation statements)

References 31 publications

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“…Other authors have reported OTLs between 360 and 625 minutes [8,18]. The median OTL in this study population was 400 mins and was significantly longer in the group with AEs than in the group without AEs (440 mins vs. 370 mins, p <0.001).…”

Section: Operative Time Lengthmentioning

confidence: 42%

“…Over the last decades, cytoreductive surgery (CRS) combined with hyperthermic intraoperative chemotherapy (HIPEC) has evolved as an effective multimodal treatment for selected patients with peritoneal surface malignancies of different origins [3][4][5][6][7]. As any complex procedure, it requires a multidisciplinary and dedicated team and a standard perioperative approach, which includes appropriate patient selection, preoperative optimization, intraoperative protocol, and adequate postoperative care to improve outcomes [8,9]. The creation and management of such meticulous groundwork can only be justified by an increase in quality of care.…”

Section: Introductionmentioning

confidence: 99%

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Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy: Analysis of Perioperative Risk Factors and Impact on Outcome

Paulo¹,

Oliveira²,

Silva³

et al. 2022

Cureus

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BackgroundCytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) is an effective treatment option for appropriately selected patients with peritoneal carcinomatosis. Our aim was to analyze a multidisciplinary approach and to study the perioperative risk factors associated with morbidity and mortality. MethodsWe reviewed all patients who underwent CRS + HIPEC from January 2019 till December 2020 at our oncologic center. Patient demographics, risk scores, intraoperative variables, postoperative care, analgesia protocol, and adverse events (AE) within 30 days after treatment were collected and statistically analyzed. ResultsOf the 98 patients evaluated preoperatively by a multidisciplinary team, 39 patients required active optimization. The median age was 61 years, and 67 were women. Most tumors were appendiceal in origin. The median peritoneal cancer index (PCI) score was 12, and the median operative time length (OTL) was 400 minutes. Body mass index, Physiological and Operative Severity Score for the enUmeration of morbidity, PCI score, crystalloid volume, cell concentrates, and OTL were associated with postoperative intensive care unit admission (p <0.05). Epidural analgesia was given to 74 patients. AEs occurred in 39 patients, and 25 of the AEs were classified as mild or moderate. The intraoperative variables associated with development of AEs were anesthesia technique, estimated blood loss, crystalloid volume, cell concentrates, OTL, and analgesia protocol (p <0.05). On multivariate analysis, crystalloid volume >6 L, intravenous sufentanil analgesic protocol, and OTL were associated with 67%, 38%, and 15% increased risk of AE, respectively. ConclusionOur study highlighted the importance of a perioperative protocol with a standardized multidisciplinary approach in order to decrease the incidence of postoperative AE.

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Section: Operative Time Lengthmentioning

confidence: 42%

Section: Introductionmentioning

confidence: 99%

Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy: Analysis of Perioperative Risk Factors and Impact on Outcome

Paulo¹,

Oliveira²,

Silva³

et al. 2022

Cureus

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“…Perioperative findings revealed an average PCI score of 12 , intraabdominal ascites measured 150 (0-3000) mL, average body temperature was 36.1°C (35)(36)(37), average lactate levels were 3 (2-7) mmol/L, Pao2/fio2 was measured as 3.3 (2.4-4.1) mm Hg, mean arterial pressure (MAP) was 60 (55-70), average surgery duration was 6.5 hours (3-14), and average blood loss was 400 (200-4000) cc. The ICU stay duration was 1.5 days (0-20), and the average hospital stay was 8.8 days (4-46).…”

Section: Resultsmentioning

confidence: 99%

“…They suggested that monitoring and maintaining diuresis at physiological levels might be as effective as sophisticated measurement of volume status. [35] Colantonio et al conducted a single-center prospective randomized study that compared GDFT with standard care in 80 patients who underwent CRS and HIPEC. In their study, patients in the control group received crystalloid infusions ranging from 4 mL/kg/h to 10 mL/kg/h, whereas those in the GDFT group received a baseline rate of 4 mL/kg/h with subsequent colloid boluses based on physiological variables.…”

Section: Discussionmentioning

confidence: 99%

The management of goal-directed fluid therapy during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Tuncel,

Düzgün

2024

Medicine

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Cytoreductive surgery is a surgical treatment approach that has been applied over the last 3 decades in patients with peritoneal metastases originating from intraabdominal organs. Goal-directed fluid therapy (GDFT) is an approach in which a patient fluid therapy during a medical procedure or surgery is carefully managed based on a specific goal. In this study, we aimed to present the results of GDFT in patients who underwent cytoreductive surgery for peritoneal carcinomatosis (PC) during the perioperative period. This retrospective study included 398 patients patient who underwent cytoreductive surgery + hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) due to PC originating from intraabdominal malignancies. Of the cases, 233 (58.6%) were female, and 165 (41.4%) were male patients. The mean age was 58.9. Perioperative findings revealed an average PC score of 12 (3–24), average lactate levels of 3 (2–7) mmol/L, Pao2/fio2 of 3.3 (2.4–4.1) mm Hg, mean arterial pressure (MAP) of 60 (55–70), average surgery duration of 6.5 hours (3–14), and average blood loss of 400 (200–4000) cc. The mean intraoperative fluid rate was 6.4 mL/kg/h (IQR 5.8–7.1). Sixteen (16.3%) patients experienced Clavien-Dindo Grade 3–4 adverse events. Within 30 days, 25 patients (6.3%) died. CRS + HIPEC procedures utilizing perioperative GDFT along with advanced anesthesia monitoring devices have shown successful application, offering an alternative to traditional and restrictive fluid management approaches.

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“…Although these physiologic perturbations inherent to the procedure represent a significative perioperative challenge, to date no standard guidelines exist concerning intraoperative management. The use of goal-directed therapy enables to individually adjust the fluid therapy, avoiding over-hydration and ensuring hemodynamic stability of patients, resulting in lower morbidity and mortality rates, as well as length of hospital stay [ 54 , 55 , 56 , 57 ]. The procedure often includes complex, multivisceral resections and blood loss is significant in the great majority of patients.…”

Section: Discussionmentioning

confidence: 99%

Complications and Mortality Rate of Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy: Italian Peritoneal Surface Malignancies Oncoteam Results Analysis

Carboni

Valle

Vaira

et al. 2022

Cancers

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Background: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy may significantly improve survival for selected patients with peritoneal surface malignancies, but it has always been criticized due to the high incidence of postoperative morbidity and mortality. Methods: Data were collected from nine Italian centers with peritoneal surface malignancies expertise within a collaborative group of the Italian Society of Surgical Oncology. Complications and mortality rates were recorded, and multivariate Cox analysis was used to identify risk factors. Results: The study included 2576 patients. The procedure was mostly performed for ovarian (27.4%) and colon cancer (22.4%). The median peritoneal cancer index was 13. Overall postoperative morbidity and mortality rates were 34% and 1.6%. A total of 232 (9%) patients required surgical reoperation. Multivariate regression logistic analysis identified the type of perfusion (p ≤ 0.0001), body mass index (p ≤ 0.0001), number of resections (p ≤ 0.0001) and colorectal resections (p ≤ 0.0001) as the strongest predictors of complications, whereas the number of resections (p ≤ 0.0001) and age (p = 0.01) were the strongest predictors of mortality. Conclusions: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is a valuable option of treatment for selected patients with peritoneal carcinomatosis providing low postoperative morbidity and mortality rates, if performed in high-volume specialized centers.

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Standard Operating Procedures for Anesthesia Management in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Improve Patient Outcomes: A Patient Cohort Analysis

Cited by 11 publications

References 31 publications

Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy: Analysis of Perioperative Risk Factors and Impact on Outcome

Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy: Analysis of Perioperative Risk Factors and Impact on Outcome

The management of goal-directed fluid therapy during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Complications and Mortality Rate of Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy: Italian Peritoneal Surface Malignancies Oncoteam Results Analysis

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