Abstract
BackgroundMacroscopic cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion (HITHOC) is a new multimodal approach for selected patients with primary and secondary pleural tumors, which may provide the patient with better local tumor control and increased overall survival rate.MethodsWe present a single-center study including 20 patients undergoing cytoreductive surgery and HITHOC between September 2008 and April 2013 at the University Medical Center Regensburg, Germany. Objective of the study was to describe the perioperative, anaesthetic management with special respect to pain and complication management.ResultsAnaesthesia during this procedure is characterized by increased intrathoracic airway and central venous pressure, hemodynamic alterations and the risk of systemic hypo- and hyperthermia. Securing an adequate intravascular volume is one of the primary goals to prevent decreased cardiac output as well as pulmonary edema. Transfusion of packed red blood cells (PRBC) was necessary in seven of 20 (35%) patients. Only two patients (10%) showed an impairment of coagulation in postoperative laboratory analysis. Perioperative forced diuresis is recommended to prevent postoperative renal insufficiency. Supplementary thoracic epidural analgesia in 13 patients (65%) showed a significant reduction of post-operative pain compared with peroral administration of opioid and non-opioid analgesics.ConclusionThis article summarizes important experiences of the anaesthesiological and intensive care management in patients undergoing HITHOC.
Highlights
Macroscopic cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion (HITHOC) is a new multimodal approach for selected patients with primary and secondary pleural tumors, which may provide the patient with better local tumor control and increased overall survival rate
This study is a retrospective review of 20 patients with primary and secondary malignant pleural tumors who underwent pleurectomy/decortication (P/D: n = 18) or extrapleural pneumonectomy (EPP: n = 2) followed by Hyperthermic intrathoracic chemotherapy perfusion (HITHOC) with cisplatin at the Department of Thoracic Surgery of the University Medical Center Regensburg between September 2008 and April 2013
Between September 2008 and April 2013, a total of 20 patients with pleural malignancies were retrospectively enrolled in this study
Summary
Macroscopic cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion (HITHOC) is a new multimodal approach for selected patients with primary and secondary pleural tumors, which may provide the patient with better local tumor control and increased overall survival rate. In spite of intensive research efforts, there has not yet been any success in establishing a standard treatment regime with curative intention for patients with primary (malignant pleural mesothelioma) and secondary (thymoma Masaoka stage IVa) malignant pleural tumors. A new multimodal treatment approach, including radio-, chemotherapy and macroscopic complete cytoreductive surgery (pleurectomy/decortication or extrapleural pneumonectomy) combined with HITHOC is available, literature so far [9] anaesthetic management is described and discussed in the following report in detail
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