The effect of intraoperative fluid administration on outcomes of patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

Abstract

Background: Determine the effect of intraoperative fluids (IOFs) administered during cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) on postoperative patient outcomes. Methods: Retrospective cohort study of patients that underwent CRS/HIPEC from February 2010 to June 2017. Results: A total of 335 patients formed the cohort study. Patients who received higher IOFs had longer hospital length of stay (LOS) (34 vs. 22.5 days; P<0.001), extended intensive care unit (ICU) admission (5.3 vs. 3.2 days; P<0.001) and a 12% increase in grade 3/4 complications (P<0.001). Greater amounts of blood product transfusion were associated with longer hospital LOS (33.7 vs. 23 days; P<0.001), and ICU admission (5 vs. 3.4 days; P<0.001) and 12% increase in grade 3/4 complications (P<0.001). When corrected for weight and peritoneal cancer index (PCI), increased transfusion of blood products still resulted in longer hospital LOS (31.2 vs. 25.2 days; P=0.04) and longer ICU admission (4.7 vs. 3.6 days; P=0.03). On multivariable analysis, less blood product transfusions demonstrated a decreased LOS in hospital by 4.8 days (P=0.01) and fewer grade 3/4 complications (OR 0.59; 95% CI, 0.35-0.99; P=0.05). Conclusions: Greater IOF administration is associated with an increase in postoperative morbidity, including hospital LOS, ICU admission and grade 3/4 complications, in patients undergoing CRS/HIPEC.

Transesophageal Echocardiography During Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy: A Novel Approach

“…Fluid administration and maintenance of euvolemia can be an anesthetic challenge. As per one study which looked at 335 cases, the median total volume of fluid administered intraoperatively was 11 liters [1]. Intraoperative under-resuscitation and hypovolemia is an established risk factor for complications [2].…”

“…Intraoperative under-resuscitation and hypovolemia is an established risk factor for complications [2]. However, excessive fluid administration has also been linked to adverse outcomes in CRS/HIPEC [1]. In patients with preserved cardiac function, an ideal strategy for fluid management has yet to be clearly established.…”

“…During the second stage, chemotherapy is infused directly into the abdominal cavity at 41-42 °C and the abdomen is manually shaken to distribute it for up to 120 minutes. On average, it is a nine-hour-long procedure, with insensible fluid losses, fluid shifts, acidosis, hypermetabolism, and hemodynamic perturbations [1]. Moreover, a certain amount of urine output (UOP) is targeted due to the nephrotoxicity of these chemotherapeutic agents, often necessitating mannitol or furosemide.…”

“…Moreover, a certain amount of urine output (UOP) is targeted due to the nephrotoxicity of these chemotherapeutic agents, often necessitating mannitol or furosemide. Because this surgery is so extensive, studies have cited a morbidity rate of up to 50% [1-4]. The hyperthermia-induced hypermetabolic state is characterized by an increase in heart rate (HR), cardiac output (CO), central venous pressure (CVP), and pulmonary capillary wedge pressure (PCWP) as well as decreased systemic vascular resistance (SVR) and decreased effective circulating volume [5-6].…”

Strategies for ‘bloodless’ surgery: the experience of cytoreductive surgery for peritoneal carcinomatosis in Jehovah's Witnesses

“…Our median total volume (5013 mL), crystalloid and albumin volume (3500 mL), and blood product volumes (1263 mL) are less than the median volumes of the aforementioned study. 20 Other potential strategies include reducing oxygen consumption and enhancing oxygen delivery. Physiological responses to infection and/or sepsis and pain can increase metabolic rate which subsequently increases tissue oxygen demands.…”