Sitoredüktif Cerrahi ve Hipertermik İntraperitoneal Kemoterapi Uygulanan Hastalarda Anestezi Yönetimi ve Perioperatif Sonuçlar
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
References
- 1. Sugarbaker PH, Cunliffe WJ, Belliveau J, et al. Rationale for integrating early postoperative intraperitoneal chemotherapy into the surgical treatment of gastrointestinal cancer. Semin Oncol. 1989;16(4 Suppl 6):83-97.
- 2. Jacquet P, Averbach A, Stephens AD, et al. Heated intraoperative intraperitoneal mitomycin C and early postoperative intraperitoneal 5-fluorouracil: pharmacokinetic studies. Oncology. 1998;55:130-138.
- 3. Van der Speeten K, Stuart OA, Sugarbaker PH. Using pharmacologic data to plan clinical treatments for patients with peritoneal surface malignancy. Curr Drug Discov Technol. 2009;6:72-81.
- 4. Schmidt C, Creutzenberg M, Piso P, et al. Peri-operative anaesthetic management of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Anaesthesia. 2008;63:389-395.
- 5. Miao N, Pingpank JF, Alexander HR, et al. Cytoreductive surgery and continuous hyperthermic peritoneal perfusion in patients with mesothelioma and peritoneal carcinomatosis: hemodynamic, metabolic, and anesthetic considerations. Ann Surg Oncol. 2008;16:334-344.
- 6. Mizumoto A, Canbay E, Hirano M, et al. Morbidity and mortality outcomes of cytoreductive surgery and hyperthermic ıntraperitoneal chemotherapy at a single ınstitution in Japan. Gastroenterol Res Pract. 2012. doi: 10.1155/2012/836425
- 7. Bezu L, Raineau M, Delomenie M, et al. Haemodynamic management during hyperthermic intraperitoneal chemotherapy: A systematic review. Anaesth Crit Care Pain Med. 2020;39:531-542.
- 8. Hakeam HA, Arab A, Azzam A, et al. Incidence of leukopenia and thrombocytopenia with cisplatin plus mitomycin-c versus melphalan in patients undergoing cytoreductive surgery (CRS) and hyperthermic ıntraperitoneal chemotherapy (HIPEC). Cancer Chemother Pharmacol. 2018;81:697-704.
- 9. Wong EYT, Tan GHC, Kumar M, et al. Hematological toxicities associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Asia Pac J Clin Oncol. 2020;16:e38-e46.
- 10. Votanopoulos K, Ihemelandu C, Shen P, et al. A comparison of hematologic toxicity profiles after heated intraperitoneal chemotherapy with oxaliplatin and mitomycin C. J Surg Res. 2013;179:e133–e139.