Pulmonary Insufficiency after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Procedures for Peritoneal Carcinomatosis in Patients with Colon Cancer: A Case Report and Literature Review

Abstract

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has emerged as an efficient treatment for patients with colorectal peritoneal metastases (PM). Pulmonary adverse events (AEs) are common after CRS and HIPEC. This report covers the case of a pulmonary adverse event, ARDS (acute respiratory distress syndrome), and its effect on the postoperative recovery process. Cytoreductive surgery with HIPEC was performed on a 68-year-old woman E. G. with carcinoma coecum and carcinomatosis. On the first day after surgery, the patient was not extubated because of respiratory insufficiency. We chose the liberal fluid management in order to maintain adequate organ perfusion, but this strategy might have influenced the outcome in this patient. Throughout the procedure that lasted 16 hours and 25 minutes the total dosage of the IV infusion was 19.7 ml/kg/h. ARDS was diagnosed based on chest radiography, oxygenation ratio, and the absence of left atrial hypertension. The patient was extubated after eleven days of ventilation. After that we started using advanced hemodynamic monitoring (esophageal Doppler) as a part of the goal-directed therapy to reduce postoperative complications and get a better outcome. The amount of fluids used during cytoreductive surgery with HIPEC may influence the postoperative pulmonary adverse event; in our case – ARDS. Cardiac output allows safer fluid titration. The goal-directed fluid therapy with advanced hemodynamic management may help in reducing the number of pulmonary adverse events after cytoreduvtive surgery with HIPEC.