Haemodynamic management during hyperthermic intraperitoneal chemotherapy: A systematic review

Abstract

ContextHyperthermic intraperitoneal chemotherapy (HIPEC) is a surgical technique for peritoneal carcinomatosis combining cytoreduction surgery and peritoneal irrigation of cytotoxic agents responsible for haemodynamics and fluid homeostasis alterations. To this day, no guidelines exist concerning intraoperative management. ObjectivesTo review data on haemodynamic monitoring and management of patients undergoing HIPEC and to help design a standardised anaesthetic protocol. Data sourcesMEDLINE, EMBASE and Cochrane library were searched using the following. Study selectionOriginal articles and case-reports. Letters to editors and reviews were excluded. Data extractionData on haemodynamic management, morbidity and mortality. Data synthesisHaemodynamic management during HIPEC is highly variable and depends on local protocols. Only one randomised controlled trial evaluated the benefit of goal-directed fluid administration (GDFA). GDFA guided by advanced haemodynamic monitoring resulted in significantly less complication, shorter length of stay and less mortality compared to standard fluid administration. Renal protection protocol did not decrease the risk of acute kidney injury (AKI). ConclusionOur review reveals that fluid administration guided by advanced monitoring seems to be associated with less postoperative morbidity and mortality after HIPEC. Nevertheless, the literature review shows that intraoperative haemodynamic management is highly variable for this surgery. The use of renal protection strategy does not decrease the prevalence of AKI. Further prospective trials comparing different fluid management and haemodynamic monitoring strategies are urgently needed (PROSPERO registration CRD42018115720)