Anesthesia Management and Perioperative Outcomes in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Year 2020, Volume: 73 Issue: 3, 276 - 282, 27.10.2020

Süheyla Karadağ Erkoç

Abstract

Objectives: Cytoreductive surgery (SRC) and hyperthermic intraperitoneal chemotherapy (HIPEC) implementation is a prolonged and complex procedure. Major blood and fluid loss, hemodynamic, hematological and metabolic changes are associated with high morbidity and mortality in the perioperative period. In this study, patients who underwent SRC and HIPEC in our operating room were retrospectively analyzed.

Materials and Methods: The files of 26 patients who underwent SRC and HIPEC were reviewed retrospectively. Preoperative, intraoperative and postoperative records were examined, blood/blood product and fluid replacements, metabolic changes, postoperative complications, length of stay in intensive care and hospital and mortality rates were evaluated.

Results: There were 26 patients included in the study, 7 of them were male and 19 were female. The primary diagnoses of the patients were ovarian cancer (42.3%), colorectal cancer (15.3%), malignant peritoneal mesothelioma (15.3%), pseudomyxoma peritonei (11.5%) and other malignant diseases (15.3%). There was a decrease in postoperative hemoglobin, hematocrit, platelet and albumin values compared to preoperative values (p<0.05). Ca, K, Mg values decreased, glucose, Cl and Na values increased (p<0.05). Grade 3-5 complications according to the Clavien-Dindo classification were observed in eight patients in the postoperative period. The presence of peritoneal cancer index and acute kidney injury was found to be a risk factor for the development of 3-5-degree complications (p<0.05). The mean operation time was 250.5±74.4 minutes. The mean length of stay in the ICU was 34.5±15.4 hours. The mean length of hospital stay was 11.2±9.5 days.

Conclusion: It is aimed to improve survival and quality of life with SRC and HIPEC. However, electrolyte and metabolic disorders with severe fluid, blood and protein losses may develop in the perioperative period. Laboratory values and hemodynamic parameters should be closely monitored to improve patient outcomes.

Key Words: Cytoreductive Surgery, Hyperthermic Intraperitoneal Chemotherapy, Perioperative Outcomes

Keywords

Cytoreductive Surgery , Hyperthermic Intraperitoneal Chemotherapy , Perioperative Outcomes

Ethical Statement

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Supporting Institution

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Sitoredüktif Cerrahi ve Hipertermik İntraperitoneal Kemoterapi Uygulanan Hastalarda Anestezi Yönetimi ve Perioperatif Sonuçlar

Abstract

Amaç: Sitoredüktif cerrahi (SRC) ve hipertermik intraperitoneal kemoterapi (HİPEK) uygulaması uzun ve kompleks bir işlemdir. Perioperatif dönemde önemli derecede kan ve sıvı kaybı, hemodinamik, hematolojik ve metabolik değişiklikler ve bunlara bağlı olarak yüksek morbidite ve mortalite ile seyretmektedir. Bu çalışmada ameliyathanemizde SRC ve HİPEK yapılan hastalar retrospektif olarak değerlendirildi.

Gereç ve Yöntem: SRC ve HİPEK uygulanan 26 hastanın dosyası retrospektif olarak tarandı. Preoperatif, intraoperatif ve postoperatif kayıtları incelenerek, yapılan kan/kan ürünü ve sıvı replasmanları, metabolik değişiklikler, postoperatif komplikasyonlar, yoğun bakım ve hastanedeki kalış süreleri ve mortalite oranları değerlendirildi.

Bulgular: Çalışmaya dahil edilen 26 hastanın 7’si erkek, 19’u kadındı. Hastaların primer tanıları sıklık sırasına göre over kanseri (%42,3), kolorektal kanser (%15,3), malign peritoneal mezotelyoma (%15,3), psödomiksoma peritonei (%11,5) ve diğer malign hastalıklardı (%15,3). Preoperatif değerler ile karşılaştırıldığında postoperatif hemoglobin, hematokrit, trombosit ve albümin değerlerinde azalma görüldü (p<0,05). Ca, K, Mg değerlerinde azalma, glukoz, Cl ve Na değerlerinde ise artış saptandı (p<0,05). Postoperatif dönemde Clavien-Dindo sınıflamasına göre sekiz hastada derece 3-5 komplikasyon görüldü. Derece 3-5 komplikasyon gelişiminde peritoneal kanser indeksi ve akut böbrek hasarı varlığı risk faktörü olarak bulundu (p<0,05). Cerrahi süre ortalama 250,5±74,4 dakikaydı. Yoğun bakımda kalış süresi ortalama 34,5±15,4 saatti. Hastanede kalış süresi ortalama 11,2±9,5 gündü.

Sonuç: SRC ve HİPEK prosedürü ile sağkalım ve yaşam kalitesinin artırılması amaçlanmaktadır. Ancak perioperatif dönemde ciddi sıvı, kan ve protein kayıpları ile birlikte elektrolit ve metabolik bozukluklar gelişebilir. Hasta sonuçlarını iyileştirmek için laboratuvar değerleri ve hemodinamik parametreler yakından izlenmelidir.

Anahtar Kelimeler: Sitoredüktif Cerrahi, Hipertermik İntraperitoneal Kemoterapi, Perioperatif Sonuçlar

Keywords

Sitoredüktif Cerrahi , Hipertermik İntraperitoneal Kemoterapi , Perioperatif Sonuçlar

Ethical Statement

Ankara Üniversitesi Diş Hekimliği FakültesiKlinik Araştırmalar Etik Kurulu’ndan alınmıştır (karar no:11/10).

Supporting Institution

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Project Number

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Thanks

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