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Risk of Intraoperative Hyperthermia and Outcomes in Adults Undergoing Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

  • Peritoneal Surface Malignancy
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Hyperthermic intraperitoneal chemotherapy (HIPEC) is commonly used to treat peritoneal surface malignancies. We aimed to identify risk factors of intraoperative patient hyperthermia and the postoperative outcome of adults undergoing HIPEC

Patients and Methods

A retrospective, IRB approved, single center cohort study was conducted. Adults treated with cytoreductive surgery and HIPEC between 2006 and 2021 were included. The primary outcome was bladder hyperthermia during perfusion, stratified by severity and duration. Secondary outcomes were postoperative complications and recurrence-free (RFS) and overall (OS) survival. Multivariable logistic regression models were fit to estimate the effects of important covariates.

Results

Out of 214 patients, 114 had mild hyperthermia (≥ 38 °C) at any time, and in 73 of these it lasted for ≥ 30 min. Independent prognostic factors of mild hyperthermia ≥ 30 min were age (OR = 0.958, 95% CI 0.933–0.984), body mas index (BMI; OR = 0.959 95% CI 0.917–1.002), gender (OR = 0.199, 95% CI 0.092–0.431), and type of chemotherapy [cisplatin versus mitomycin (OR = 0.186, 95% CI 0.070–0.491; oxaliplatin versus mitomycin (OR = 0.430, 95% CI 0.163–1.139)]. Prognostic factors of moderate-to-severe hyperthermia (≥ 39 °C) at any time were perfusion duration (OR = 1.094, 95% CI 1.018–1.177) and blood transfusion (OR = 5.689, 95% CI 1.784–18.137). Intraoperative hyperthermia was not associated with increased postoperative complications but was associated with better RFS and OS.

Conclusions

Our study demonstrates age, gender, BMI, and chemotherapy type to be associated with hyperthermia ≥ 38 °C for ≥ 30 min, whereas longer perfusion time and blood transfusion were associated with hyperthermia ≥ 39 °C. Mild hyperthermia at the end of perfusion is associated with better RFS and OS.

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References

  1. van Driel WJ, Koole SN, Sikorska K, et al. Hyperthermic Intraperitoneal Chemotherapy in Ovarian Cancer. NEJM. 2018;378(3):230–40. https://doi.org/10.1056/NEJMoa1708618.

    Article  PubMed  Google Scholar 

  2. Desiderio J, Chao J, Melstrom L, et al. The 30-year Experience—a Meta-analysis of Randomised and High-Quality Non-randomised Studies of Hyperthermic Intraperitoneal Chemotherapy in the Treatment of Gastric Cancer. Eur J Cancer. 2017;79:1–14. https://doi.org/10.1016/j.ejca.2017.03.030.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Levinsky NC, Morris MC, Wima K, et al. Should We Be Doing Cytoreductive Surgery with Hipec for Signet Ring Cell Appendiceal Adenocarcinoma? A Study from the US HIPEC Collaborative. J Gastrointest Surg. 2019. https://doi.org/10.1007/s11605-019-04336-4.

    Article  PubMed  Google Scholar 

  4. Begossi G, Gonzalez-Moreno S, Ortega-Perez G, Fon LJ, Sugarbaker PH. Cytoreduction and Intraperitoneal Chemotherapy for the Management of Peritoneal Carcinomatosis, Sarcomatosis and Mesothelioma. Eur J Surg Oncol. 2002;28(1):80–7. https://doi.org/10.1053/ejso.2001.1152.

    Article  CAS  PubMed  Google Scholar 

  5. Hendrix RJ, Kassira JP, Lambert LA. Elevated Maximum core Body Temperature During Hyperthermic Intraperitoneal Chemoperfusion (HIPEC) is Associated with Increased Postoperative Complications. Ann Surg Oncol. 2020;27(1):232–9. https://doi.org/10.1245/s10434-019-07495-5.

    Article  PubMed  Google Scholar 

  6. Solanki SL, Mukherjee S, Agarwal V, et al. Society of Onco-Anaesthesia and Perioperative Care Consensus Guidelines for Perioperative Management of Patients for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS-HIPEC). Indian J Anaesth. 2019;63(12):972–87. https://doi.org/10.4103/ija.IJA_765_19.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Kanakoudis F, Petrou A, Michaloudis D, Chortaria G, Konstantinidou A. Anaesthesia for Intra-peritoneal Perfusion of Hyperthermic Chemotherapy Haemodynamic Changes, Oxygen Consumption and Delivery. Anaesthesia. 1996;51(11):1033–6. https://doi.org/10.1111/j.1365-2044.1996.tb14998.x.

    Article  CAS  PubMed  Google Scholar 

  8. Cafiero T, Di Iorio C, Di Minno RM, Sivolella G, Confuorto G. Non-invasive Cardiac Monitoring by Aortic Blood Flow Determination in Patients Undergoing Hyperthermic Intraperitoneal Intraoperative Chemotherapy. Minerva Anestesiol. 2006;72(4):207–15.

    CAS  PubMed  Google Scholar 

  9. 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;12(1):136. https://doi.org/10.1186/1477-7819-12-136.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kurz A, Sessler DI, Lenhardt R. Perioperative Normothermia to Reduce the Incidence of Surgical-Wound Infection and Shorten Hospitalization. Study of Wound Infection and Temperature Group. NEJM. 1996;334(19):1209–15. https://doi.org/10.1056/NEJM199605093341901.

    Article  CAS  PubMed  Google Scholar 

  11. Kumar A, Suman S, Pandey JK, Sinha C. Does Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Decrease the Threshold of Arrhythmia Intraoperatively? Asian J Anesthesiol. 2019;57(1):21–2. https://doi.org/10.6859/aja.201903_57(1).0005.

    Article  PubMed  Google Scholar 

  12. Grigore AM, Murray CF, Ramakrishna H, Djaiani G. A Core Review of Temperature Regimens and Neuroprotection During Cardiopulmonary Bypass: Does Rewarming Rate Matter? Anesth Analg. 2009;109(6):1741–51. https://doi.org/10.1213/ANE.0b013e3181c04fea.

    Article  PubMed  Google Scholar 

  13. Helderman R, Löke DR, Verhoeff J, et al. The Temperature-Dependent Effectiveness of Platinum-Based Drugs Mitomycin-C and 5-fu During Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Colorectal Cancer Cell Lines. Cells. 2020. https://doi.org/10.3390/cells9081775.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo Classification of Surgical Complications: Five-Year Experience. Ann Surg. 2009;250(2):187–96. https://doi.org/10.1097/SLA.0b013e3181b13ca2.

    Article  PubMed  Google Scholar 

  15. Owusu-Agyemang P, Zavala AM, Williams UU, et al. Assessing the Impact of Perioperative Blood Transfusions on the Survival of Adults Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Appendiceal Carcinomatosis. Vox Sang. 2017;112(6):567–77. https://doi.org/10.1111/vox.12546.

    Article  CAS  PubMed  Google Scholar 

  16. Turaga K, Levine E, Barone R, et al. Consensus Guidelines from The American Society of Peritoneal Surface Malignancies on Standardizing the Delivery of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Colorectal Cancer Patients in the United States. Ann Surg Oncol. 2014;21(5):1501–5. https://doi.org/10.1245/s10434-013-3061-z.

    Article  CAS  PubMed  Google Scholar 

  17. Schmidt C, Creutzenberg M, Piso P, Hobbhahn J, Bucher M. Peri-operative Anaesthetic Management of Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy. Anaesthesia. 2008;63(4):389–95. https://doi.org/10.1111/j.1365-2044.2007.05380.x.

    Article  CAS  PubMed  Google Scholar 

  18. Pandit A, Singh V, Bharati SJ, Mishra S, Deo SV, Bhatnagar S. A Pilot Randomised Clinical Trial Comparing Desflurane Anaesthesia Versus Total Intravenous Anaesthesia, for Changes in Haemodynamic, Inflammatory and Coagulation Parameters in Patients Undergoing Hyperthermic Intraperitoneal Chemotherapy. Indian J Anaesth. 2020;64(8):688–95. https://doi.org/10.4103/ija.IJA_34_20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Goldenshluger M, Zippel D, Ben-Yaacov A, et al. Core Body Temperature but Not Intraabdominal Pressure Predicts Postoperative Complications Following Closed-System Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Administration. Ann Surg Oncol. 2018;25(3):660–6. https://doi.org/10.1245/s10434-017-6279-3.

    Article  CAS  PubMed  Google Scholar 

  20. Kim MH, Yoo YC, Bai SJ, Lee KY, Kim N, Lee KY. Physiologic and Hemodynamic Changes in Patients Undergoing Open Abdominal Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy. Int J Med Res. 2021;49(1):300060520983263. https://doi.org/10.1177/0300060520983263.

    Article  CAS  Google Scholar 

  21. De Somer F, Ceelen W, Delanghe J, et al. Severe Hyponatremia, Hyperglycemia, and Hyperlactatemia are Associated with intraoPerative Hyperthermic Intraperitoneal Chemoperfusion with Oxaliplatin. Perit Dial Int. 2008;28(1):61–6.

    Article  Google Scholar 

  22. Chichura A, Chambers LM, Costales AB, et al. Impact of Intra-operative Factors Upon Peri-operative Outcomes in Women Undergoing Hyperthermic Intraperitoneal Chemotherapy for Gynecologic Cancer. Gynecol Oncol. 2021. https://doi.org/10.1016/j.ygyno.2021.01.006.

    Article  PubMed  Google Scholar 

  23. Malfroy S, Wallet F, Maucort-Boulch D, et al. Complications after Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Treatment of Peritoneal Carcinomatosis: Risk Factors for ICU Admission and Morbidity Prognostic Score. Surg Oncol. 2016;25(1):6–15. https://doi.org/10.1016/j.suronc.2015.11.003.

    Article  PubMed  Google Scholar 

  24. Sato Y, Roncal-Jimenez CA, Andres-Hernando A, et al. Increase of Core Temperature Affected the Progression of Kidney Injury by Repeated Heat Stress Exposure. Am J Physiol Renal Physiol. 2019;317(5):F1111–21. https://doi.org/10.1152/ajprenal.00259.2019.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Quénet F, Elias D, Roca L, et al. Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy Versus Cytoreductive Surgery Alone for Colorectal Peritoneal Metastases (PRODIGE 7): A Multicentre, Randomised, Open-Label, Phase 3 Trial. Lancet Oncol. 2021;22(2):256–66. https://doi.org/10.1016/s1470-2045(20)30599-4.

    Article  CAS  PubMed  Google Scholar 

  26. Rettenmaier MA, Mendivil AA, Gray CM, et al. Intra-Abdominal Temperature Distribution During Consolidation Hyperthermic Intraperitoneal Chemotherapy with Carboplatin in the Treatment of Advanced Stage Ovarian Carcinoma. Int J Hyperthermia. 2015;31(4):396–402. https://doi.org/10.3109/02656736.2015.1007399.

    Article  CAS  PubMed  Google Scholar 

  27. Grotz TE, Overman MJ, Eng C, et al. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Moderately and Poorly Differentiated Appendiceal Adenocarcinoma: Survival Outcomes and Patient Selection. Ann Surg Oncol. 2017;24(9):2646–54. https://doi.org/10.1245/s10434-017-5938-8.

    Article  PubMed  Google Scholar 

  28. Cata JP, Fournier K, Corrales G, et al. The Impact of Thoracic Epidural Analgesia Versus Four Quadrant Transversus Abdominis Plane Block on Quality of Recovery After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy Surgery: A Single-Center, Noninferiority, Randomized, Controlled Trial. Ann Surg Oncol. 2021. https://doi.org/10.1245/s10434-021-09622-7.

    Article  PubMed  Google Scholar 

  29. González-Moreno S, González-Bayón LA, Ortega-Pérez G. Hyperthermic Intraperitoneal Chemotherapy: Rationale and Technique. World J Gastrointest Oncol. 2010;2(2):68–75. https://doi.org/10.4251/wjgo.v2.i2.68.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Ceelen W, De Somer F, Van Nieuwenhove Y, Vande Putte D, Pattyn P. Effect of Perfusion Temperature on Glucose and Electrolyte Transport During Hyperthermic Intraperitoneal Chemoperfusion (HIPEC) with Oxaliplatin. Eur J Surg Oncol. 2013;39(7):754–9. https://doi.org/10.1016/j.ejso.2012.07.120.

    Article  CAS  PubMed  Google Scholar 

  31. Halkia E, Tsochrinis A, Vassiliadou DT, et al. Peritoneal Carcinomatosis: Intraoperative Parameters in Open (Coliseum) Versus Closed Abdomen HIPEC. Int J Surg Oncol. 2015;2015:610597–610597. https://doi.org/10.1155/2015/610597.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Carlos E. Guerra-Londono MD, Pascal Owusu-Agyemang MD, German Corrales MD & Juan P. Cata MD

  2. Baylor College of Medicine, Houston, TX, USA

    Marina M. Rofaeil BS

  3. Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Lei Feng MS

  4. Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Keith Fournier MD

  5. Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA

    Pascal Owusu-Agyemang MD, German Corrales MD, Keith Fournier MD & Juan P. Cata MD

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  1. Carlos E. Guerra-Londono MD
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Correspondence to Juan P. Cata MD.

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Guerra-Londono, C.E., Owusu-Agyemang, P., Corrales, G. et al. Risk of Intraoperative Hyperthermia and Outcomes in Adults Undergoing Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Ann Surg Oncol 29, 2089–2099 (2022). https://doi.org/10.1245/s10434-021-10929-8

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