Goal-directed therapy in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a prospective observational study
Cytoreductive surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in peritoneal carcinomatosis treatment causes significant hemodynamic, metabolic, and hematological alterations. Studies on the anesthetic intraoperative management are heterogeneous and scarce. There is a great heterogeneity in the anesthetic management of CRS and HIPEC. The aim of this study is to analyze perioperative hemodynamic goal-directed management and to evaluate the complications arisen until the seventh postoperative day.
Prospective, observational study of all CRS and HIPEC patients from March 2014 to May 2017. Hemodynamic and clinical parameters were registered during surgery and the first 3 postoperative days. We correlated intraoperative data with the postoperative course until the seventh day.
A total of 92 patients were included in the study (age 58.5 ± 10.9 years, 47% colorectal carcinoma, and 38% ovarian carcinoma). Peritoneal Carcinomatosis Index (PCI) (median and ranges) was 10 [0–39]. Cardiac Index (CI) 3.15 l/min−1/m−2 [1.79–5.60]) and Systolic Volume Variation (SVV) (10% [3%–17%]) remained within the values of normality in all surgery phases. A large difference was observed between the minimum and maximum ranges of fluid therapy administered (median 9.8 ml/kg/h [5.3–24.3]), showing a great interindividual variation in the fluids requirement. A direct relationship was observed between PCI and surgery duration, fluid therapy, and intraoperative transfusion percentage (p < 0.02).
There is a great variability in the intraoperative fluid therapy needs of the patients. SVV monitoring makes it possible to adjust the fluid therapy needs in each surgery phase. The use of a hemodynamic goal-directed anesthetic protocol in CRS and HIPEC enables to individually adjust the fluid therapy, avoiding over-hydration and ensuring hemodynamic stability in all surgery phases.
KeywordsPeritoneal carcinomatosis HIPEC Anesthesia Goal-directed therapy
The authors want to thank to all members of the Peritoneal Surgical Oncology Unit, anesthesiologists, surgeons, and nurses.
NEP, AFR, and GGR were responsible for conceptualizing and designing the study, collecting, analyzing, and interpreting the data, and drafting the manuscript. MVR and DFG contributed to the conception and design of the study and to the revision of the manuscript. LCMF, RMS, and JJSS were responsible for the critical revision of the intellectual content of the manuscript. STG contributed to the analysis and interpretation of the data. All authors gave their approval on the final version for publication.
Compliance with ethical standards
Conflict of interest
Drs. Neus Esteve Pérez, Ana Ferrer-Robles, Germán Gómez-Romero, David Fabián-Gonzalez, Mateo Verd-Rodriguez, Luis Carlos Mora-Fernández, Rafael Morales-Soriano, Juan José Segura-Sampedro, and Silvia Tejada-Gavela have no conflicts of interest or financial ties to disclose.
The study was approved by the Clinical Investigation Ethical Committee of the Balearic Islands Government (Palma de Mallorca, Balearic Islands, Spain) with number IB 2381/14. The protocol procedures were designed in compliance with the clinical research recommendations of the 1964 Declaration of Helsinki.
Research involving human participants or animals
This article does not contain any study with animals performed by any of the authors.
All participants were informed about the research protocol before giving their written consent to participate in the study.
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