Abstract
Background and Objectives Postoperative thromboembolism is a significant cause of prolonged recovery in patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Thromboelastography (TEG) can detect hypercoagulable states and predict thromboembolic complications after surgery. This study assessed the impact of CRS and HIPEC on TEG values. Methods TEG parameters reaction time (R), kinetics time (K), angle (α), maximum amplitude (MA), and lysis percent at 60 min (LY60) were determined preoperatively, and at the end of CRS, during HIPEC, and at the end of the operation using blood samples from 15 HIPEC patients. Platelets, P-TT, and aPTT were also determined before and after CRS. Results A total of 75 samples were analyzed. During CRS, there was a significant reduction in the mean MA (3.06 mm, p = 0.001). The mean P-TT declined by 32% (p < 0.001) and mean platelets by 55 × 109/L (p < 0.001). During HIPEC, the mean R and K shortened by 1.04 min (p = 0.015) and 0.18 min (p = 0.018), respectively, whereas α increased by 2.48° (p = 0.005). Conclusions During CRS, both TEG and conventional laboratory tests indicated hypocoagulation. During HIPEC, however, the initiation of coagulation and the kinetics of thrombin formation were accelerated.
Highlights
Cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) has become an established treatment of peritoneal malignancies such as pseudomyxoma peritonei, abdominal mesothelioma and colon carcinoma with peritoneal carcinomatosis
Most of the patients were overweight or obese; one patient was slightly underweight with a BMI of 17.5
During HIPEC, we observed a shortening in R, reflecting enhanced initiation of coagulation, and a prolongation in K and an elevation in a, suggesting acceleration in the kinetics of thrombin formation
Summary
Cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) has become an established treatment of peritoneal malignancies such as pseudomyxoma peritonei, abdominal mesothelioma and colon carcinoma with peritoneal carcinomatosis. There are only few studies where DVT was systematically screened by ultrasound or venography after oncologic surgery. In these studies, venous thrombosis was diagnosed in 8–13% of patients [7,8,9]. Venous thrombosis was diagnosed in 8–13% of patients [7,8,9] Postoperative thromboembolism is a significant cause of prolonged recovery in patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Methods: TEG parameters reaction time (R), kinetics time (K), angle (a), maximum amplitude (MA), and lysis percent at 60 min (LY60) were determined preoperatively, and at the end of CRS, during HIPEC, and at the end of the operation using blood samples from 15 HIPEC patients. During HIPEC, the initiation of coagulation and the kinetics of thrombin formation were accelerated
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