Anaesthesia in patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: retrospective analysis of a single centre three-year experience

Marie-Elisabeth Kajdi,Ulrike Held,Kuno Lehmann,Reto Kofmehl,Beatrice Beck-Schimmer,Michael Thomas Ganter

doi:10.1186/1477-7819-12-136

Abstract

BackgroundCytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is a treatment option for selected patients with peritoneal carcinomatosis. There are limited data available on anaesthesia management and its impact on patients’ outcome. Our aim was to retrospectively analyze and evaluate perioperative management and the clinical course of patients undergoing CRS/HIPEC within a three-year period.MethodsAfter ethic committee approval, patient charts were retrospectively reviewed for patient characteristics, interventions, perioperative management, postoperative course, and complications. Analysis was intervention based. Data are presented as median (range).ResultsBetween 2009 and 2011, 54 consecutive patients underwent 57 interventions; median anaesthesia time was 715 (range 370 to 1135) minutes. HIPEC induced hyperthermia with an overall median peak temperature of 38.1 (35.7-40.2)°C with active cooling. Bleeding, expressed as median blood loss was 0.8 (0 to 6) litre and large fluid shifts occurred, requiring a total fluid input of 8.4 (4.2 to 29.4) litres per patient. Postoperative renal function was dependent on preoperative function and the type of fluids used. Administration of hydroxyethyl starch colloid solution had a significant negative impact on renal function, especially in younger patients. Major complications occurred after 12 procedures leading to death in 2 patients. Procedure time and need for blood transfusion were associated with a significantly higher risk for major complications.ConclusionsCytoreductive surgery with HIPEC is a high-risk surgical procedure associated with major hemodynamic and metabolic changes. As well as primary disease and complexity of surgery, we have shown that anaesthesia management, the type and amount of fluids used, and blood transfusions may also have a significant effect on patients’ outcome.

Highlights

Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is a treatment option for selected patients with peritoneal carcinomatosis
Over the last two decades, cytoreductive surgery combined with hyperthermic intraoperative chemotherapy (CRS/ HIPEC) has become a therapeutic option for selected patients with peritoneal carcinomatosis [1]
The majority of patients suffered from cancer originating from the vermiform appendix

Summary

Introduction

Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is a treatment option for selected patients with peritoneal carcinomatosis. There are limited data available on anaesthesia management and its impact on patients’ outcome. Our aim was to retrospectively analyze and evaluate perioperative management and the clinical course of patients undergoing CRS/HIPEC within a three-year period. Over the last two decades, cytoreductive surgery combined with hyperthermic intraoperative chemotherapy (CRS/ HIPEC) has become a therapeutic option for selected patients with peritoneal carcinomatosis [1]. Sugarbaker [3], first described that some of these patients may benefit from the surgical removal of all macroscopic tumor, combined with locoregional chemotherapy [3]. Strict patient selection is crucial and meticulous surgical tumor removal is mandatory for the best clinical outcome [9,12,13,14]. Several authors have shown major changes in body temperature and hemodynamics, alterations in the composition of the blood as well as need for massive transfusion [18,19,20,21]

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