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Goal-directed therapy in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a prospective observational study

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Abstract

Background

Cytoreductive surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in peritoneal carcinomatosis treatment causes significant hemodynamic, metabolic, and hematological alterations. Studies on the anesthetic intraoperative management are heterogeneous and scarce. There is a great heterogeneity in the anesthetic management of CRS and HIPEC. The aim of this study is to analyze perioperative hemodynamic goal-directed management and to evaluate the complications arisen until the seventh postoperative day.

Methods

Prospective, observational study of all CRS and HIPEC patients from March 2014 to May 2017. Hemodynamic and clinical parameters were registered during surgery and the first 3 postoperative days. We correlated intraoperative data with the postoperative course until the seventh day.

Results

A total of 92 patients were included in the study (age 58.5 ± 10.9 years, 47% colorectal carcinoma, and 38% ovarian carcinoma). Peritoneal Carcinomatosis Index (PCI) (median and ranges) was 10 [0–39]. Cardiac Index (CI) 3.15 l/min−1/m−2 [1.79–5.60]) and Systolic Volume Variation (SVV) (10% [3%–17%]) remained within the values of normality in all surgery phases. A large difference was observed between the minimum and maximum ranges of fluid therapy administered (median 9.8 ml/kg/h [5.3–24.3]), showing a great interindividual variation in the fluids requirement. A direct relationship was observed between PCI and surgery duration, fluid therapy, and intraoperative transfusion percentage (p < 0.02).

Conclusions

There is a great variability in the intraoperative fluid therapy needs of the patients. SVV monitoring makes it possible to adjust the fluid therapy needs in each surgery phase. The use of a hemodynamic goal-directed anesthetic protocol in CRS and HIPEC enables to individually adjust the fluid therapy, avoiding over-hydration and ensuring hemodynamic stability in all surgery phases.

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References

  1. Raue W, Tsilimparis N, Bloch A, Menenakos C, Hartmann J. Volume therapy and cardiocircular function during hyperthermic intraperitoneal chemotherapy. Eur Surg Res. 2009;43(4):365–72.

    Article  CAS  PubMed  Google Scholar 

  2. Thong SY, Chia CS, Ng O, Tan G, Ong ET, Soo KC, Teo M. A review of 111 anaesthetic patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Singap Med J. 2016. https://doi.org/10.11622/smedj.2016078 [Epub ahead of print].

    Article  Google Scholar 

  3. Thanigaimani K, Mohamed F, Cecil T, Moran BJ, Bell J. The use of cardiac output monitoring to guide the administration of intravenous fluid during hyperthermic intraperitoneal chemotherapy. Colorectal Dis. 2013;15(12):1537–42.

    Article  CAS  PubMed  Google Scholar 

  4. Pascual J, Sanchez S, Gonzalez F, Villarejo P, López de la Manzanara C, Haya J, Padilla D, Martin J. Security and efficiency of a closed-system, turbulent-flow circuit for HIPEC after cytoreductive ovarían surgery: perioperative outputs. Arch Gynecol Obstet. 2014;290:121–9.

    Article  CAS  Google Scholar 

  5. Korakianitis O, Daskalou T, Alevizos L, Stamou K, Mavroudis C, Iatrou C, Vogiatzaki T, Eleftheriadis S, Tentes AA. Lack of significant intraoperative coagulopathy in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) indicates that epidural anaesthesia is a safe option. Int J Hyperthermia. 2015;8:1–6.

    Google Scholar 

  6. Falcón Araña L, Fuentes-García D, Roca Calvo MJ, Hernández-Palazón J, Gil Martínez J, Cascales Campos PA, Acosta Villegas FJ, Parrilla Paricio P. Alterations in hemostasis during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with peritoneal carcinomatosis. Cir Esp. 2015;93(8):496–501.

    Article  PubMed  Google Scholar 

  7. Schluermann CN, Hoeppner J, Benk C, Schmidt R, Loop T, Kalbhenn J. Intraabdominal pressure, cardiac index and vascular resistance during hyperthermic intraperitoneal chemotherapy: a prospective observational study. Minerva Anestesiol. 2016;82(2):160–9.

    PubMed  Google Scholar 

  8. Coccolini F, Corbella D, Finazzi P, Brambillasca P, Benigni A, Prussiani V, Ceresoli M, Manfredi R, Poiasina E, Bertoli P, Catena F, Bianchetti A, Bontempelli M, Lorini LF, Sonzogni V, Ansaloni L. Time course of cytokines, hemodynamic and metabolic parameters during hyperthermic intraperitoneal chemotherapy. Minerva Anestesiol. 2016;82(3):310–9.

    PubMed  Google Scholar 

  9. Colantonio L, Claroni C, Fabrizi L, Marcelli ME, Sofra M, Giannarelli D, Garofalo A, Forastiere E. A randomized trial of goal directed vs standard fluid therapy in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. J Gastrointest Surg. 2015;19(4):722–9.

    Article  PubMed  Google Scholar 

  10. Rollins KE, Lobo DN. Intraoperative goal-directed fluid therapy in elective major abdominal surgery: a meta-analysis of randomized controlled trials. Ann Surg. 2016;263:465–76.

    Article  PubMed  Google Scholar 

  11. Pearse RM, Harrison DA, MacDonald N, Gillies MA, Blunt M, Ackland G, Grocott MP, Ahern A, Griggs K, Scott R, Hinds C, Rowan K, OPTIMISE Study Group. Effect of a perioperative, cardiac output-guided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery: a randomized clinical trial and systematic review. JAMA. 2014;311:2181–90.

    Article  CAS  PubMed  Google Scholar 

  12. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Shiralkar SP, Kerr P, Scott J, Sivalingam P. Anaesthetic management of patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei: a retrospective audit. Anaesth Intensive Care. 2017;45(4):490–8.

    Article  CAS  PubMed  Google Scholar 

  14. Kajdi ME, Beck-Schimmer B, Held U, Kofmehl R, Lehmann K, Ganter MT. Anaesthesia in patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: retrospective analysis of a single centre three-year experience. World J Surg Oncol. 2014;1(12):136.

    Article  Google Scholar 

  15. Mavroudis C, Alevizos L, Stamou K, Vogiatzaki T, Eleftheriadis S, Korakianitis O, Tentes A, Iatrou C. Hemodynamic monitoring during heated intraoperative intraperitoneal chemotherapy using the FloTrac/Vigileo™ system. Int Surg. 2015;100(6):1033–9.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Redondo FJ, Padilla D, Villarejo P, Baladron V, Faba P, Sánchez S, Muñoz-Rodríguez JR, Bejarano N. The global end-diastolic volume (GEDV) could be more appropiate to fluid management than central venous pressure (CVP) during closed hyperthermic intrabdominal chemotherapy with CO2 circulation. J Invest Surg. 2017;30:1–7.

    Article  Google Scholar 

  17. Bell JC, Rylah BG, Chambers RW, Peet H, Mohamed F, Moran BJ. Perioperative management of patients undergoing cytoreductive surgery combined with heated intraperitoneal chemotherapy for peritoneal surface malignancy: a multi-institutional experience. Ann Surg Oncol. 2012;19(13):4244–51.

    Article  PubMed  Google Scholar 

  18. Morales-Soriano R, Esteve-Pérez N, Segura-Sampedro JJ, Cascales-Campos P, Barrios P; Spanish Group of peritoneal malignancy surface (GECOP). Current practice in cytoreductive surgery and HIPEC for metastatic peritoneal disease: Spanish multicentric survey. Eur J Surg Oncol. 2017. pii: S0748-7983(17)30974-5

  19. Owusu-Agyemang P, Soliz J, Hayes-Jordan A, Harun N, Gottumukkala V. Safety of epidural analgesia in the perioperative care of patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2014;21(5):1487–9.

    Article  PubMed  Google Scholar 

  20. Roeb MM, Wolf A, Gräber SS, Meiner W, Volk T. Epidural versus systemic analgesia: an international registry analysis on postoperative pain and related perceptions after abdominal surgery. Clin J Pain. 2017;33(3):189–97.

    PubMed  Google Scholar 

  21. Kooij F, Schlack WS, Preckel B, Hollmann MW. Does regional analgesia for major surgery improve outcome?. Focus on epidural analgesia. Anesth Analg. 2014;119(3):740–4.

    Article  PubMed  Google Scholar 

  22. Mehta AM, Huitema AD, Burger JW, Brandt-Kerkhof AR, van den Heuvel SF, Verwaal VJ. Standard clinical protocol for bidirectional hyperthermic intraperitoneal chemotherapy (HIPEC): systemic leucovorin, 5-fluorouracil, and heated intraperitoneal oxaliplatin in a chloride-containing carrier solution. Ann Surg Oncol. 2017;24:990–7.

    Article  PubMed  Google Scholar 

  23. Arjona-Sánchez A, Cadenas-Febres A, Cabrera-Bermon J, Muñoz-Casares FC, Casado-Adam A, Sánchez-Hidalgo JM, López-Andreu M, Briceño-Delgado J, Rufián-Peña S. Assessment of RIFLE and AKIN criteria to define acute renal dysfunction for HIPEC procedures for ovarian and non-ovarian peritoneal malignances. Eur J Surg Oncol. 2016;42(6):869–76.

    Article  PubMed  Google Scholar 

  24. Hakeam HA, Breakiet M, Azzam A, Nadeem A, Amin T. The incidence of cisplatin nephrotoxicity post hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery. Ren Fail. 2014;36(10):1486–91.

    Article  CAS  PubMed  Google Scholar 

  25. Oh GS, Kim HJ, Shen A, Lee SB, Khadka D, Pandit A, So HS. Cisplatin-induced kidney dysfunction and perspectives on improving treatment strategies. Electrolyte Blood Press. 2014;12:55–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Kellum JA, Lameire N, KDIGO AKI Guideline Work Group. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care. 2013;17(1):20.

    Article  Google Scholar 

  27. Eng OS, Dumitra S, O’Leary M, Wakabayashi M, Dellinger TH, Han ES, Lee SJ, Paz IB, Lee B. Base excess as a predictor of complications in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2017;24(9):2707–11.

    Article  PubMed  Google Scholar 

  28. Baumgartner JM, Kwong TG, Ma GL, Messer K, Kelly KJ, Lowy AM. A novel tool for predicting major complications after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2016;23(5):1609–17.

    Article  PubMed  Google Scholar 

  29. Jafari MD, Halabi WJ, Stamos MJ, Nguyen VQ, Carmichael JC, Mills SD, Pigazzi A. Surgical outcomes of hyperthermic intraperitoneal chemotherapy: analysis of the American College of Surgeons National Surgical Quality Improvement Program. JAMA Surg. 2014;149(2):170–5.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors want to thank to all members of the Peritoneal Surgical Oncology Unit, anesthesiologists, surgeons, and nurses.

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Authors and Affiliations

  1. Department of Anesthesiology, University Hospital Son Espases, Ctra. Valldemosa 79, 07010, Palma, Spain

    N. Esteve-Pérez, A. Ferrer-Robles, G. Gómez-Romero, D. Fabián-Gonzalez, M. Verd-Rodriguez & L. C. Mora-Fernandez

  2. Malignant Peritoneal Disease Research Group, Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain

    N. Esteve-Pérez, A. Ferrer-Robles, G. Gómez-Romero, D. Fabián-Gonzalez, M. Verd-Rodriguez, L. C. Mora-Fernandez, J. J. Segura-Sampedro & R. Morales-Soriano

  3. Peritoneal Surgical Oncology Unit, Department of General and Digestive Surgery, University Hospital Son Espases, Palma, Spain

    J. J. Segura-Sampedro & R. Morales-Soriano

  4. Laboratory of Neurophysiology, Department of Biology, University of the Balearic Islands, Palma, Spain

    S. Tejada-Gavela

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  1. N. Esteve-Pérez
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  4. D. Fabián-Gonzalez
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  5. M. Verd-Rodriguez
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  8. S. Tejada-Gavela
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Contributions

NEP, AFR, and GGR were responsible for conceptualizing and designing the study, collecting, analyzing, and interpreting the data, and drafting the manuscript. MVR and DFG contributed to the conception and design of the study and to the revision of the manuscript. LCMF, RMS, and JJSS were responsible for the critical revision of the intellectual content of the manuscript. STG contributed to the analysis and interpretation of the data. All authors gave their approval on the final version for publication.

Corresponding author

Correspondence to N. Esteve-Pérez.

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Conflict of interest

Drs. Neus Esteve Pérez, Ana Ferrer-Robles, Germán Gómez-Romero, David Fabián-Gonzalez, Mateo Verd-Rodriguez, Luis Carlos Mora-Fernández, Rafael Morales-Soriano, Juan José Segura-Sampedro, and Silvia Tejada-Gavela have no conflicts of interest or financial ties to disclose.

Ethical Standard

The study was approved by the Clinical Investigation Ethical Committee of the Balearic Islands Government (Palma de Mallorca, Balearic Islands, Spain) with number IB 2381/14. The protocol procedures were designed in compliance with the clinical research recommendations of the 1964 Declaration of Helsinki.

Research involving human participants or animals

This article does not contain any study with animals performed by any of the authors.

Informed consent

All participants were informed about the research protocol before giving their written consent to participate in the study.

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Esteve-Pérez, N., Ferrer-Robles, A., Gómez-Romero, G. et al. Goal-directed therapy in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a prospective observational study. Clin Transl Oncol 21, 451–458 (2019). https://doi.org/10.1007/s12094-018-1944-y

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  • DOI: https://doi.org/10.1007/s12094-018-1944-y

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