An acute cardiac complication of HIPEC

Abstract

Recently, cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) has been described for both treatment and prevention of locoregional cancer of various origin. As this procedure involves large amount of blood and fluid loss during the CRS phase, and haemodynamic, metabolic, and coagulation changes during the HIPEC phase, thus thorough study and evaluation is needed to reduce the morbidity and mortality associated with this newer modality in treatment of cancer patients. We hereby describe a case report where a patient developed acute cardiac dysfunction in the immediate postoperative period following CRS with HIPEC. A 65 years old patient weighing 62 kg had undergone CRS with HIPEC for ovarian carcinoma. She had a blood loss of 1.5 L and ascetic fluid drainage of 1.5 L. Intraoperatively fluid was given according to stroke volume variation and two pack cell was transfused to maintain haemoglobin above 10 g. Two hours postoperatively she suddenly developed severe hypotension and an echocardiography done revealed a global left ventricular dysfunction with a 28% ejection fraction. She was intubated and put on inotropic support. Utrasound abdomen revealed fluids and features suggestive of intestinal perforation. So she was reopened on the 3rd postoperative day and primary closure of the intestinal perforation was done. Thereafter she became haemodynamically stable and we were able to extubate her on the fourth post operative day. Thus we conclude that goal directed fluid therapy with advanced monitoring, thorough evaluation, skeptical vigilance and preemtive thinking is required to deal with the challenges posed by CRS with HIPEC.