Annals of Surgical Oncology

, Volume 23, Issue 8, pp 2419–2429 | Cite as

Evaluating the Impact of Total Intravenous Anesthesia on the Clinical Outcomes and Perioperative NLR and PLR Profiles of Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy

  • Pascal Owusu-AgyemangEmail author
  • Juan P. Cata
  • Keith F. Fournier
  • Acsa M. Zavala
  • Jose Soliz
  • Mike Hernandez
  • Andrea Hayes-Jordan
  • Vijaya Gottumukkala
Gastrointestinal Oncology



The aim of this study was to assess the impact of total intravenous anesthesia (TIVA) on the perioperative inflammatory profile and clinical outcomes of patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS–HIPEC).


A retrospective review of patients undergoing CRS–HIPEC was performed. Patients receiving a combination of preoperative tramadol extended release (ER), celecoxib, and pregabalin, along with combined intraoperative infusions of propofol, dexmedetomidine, lidocaine, and ketamine were classified as receiving a TIVA regimen (TIVA group). The second group consisted of patients receiving volatile–opioid-based anesthesia (VO group). The neutrophil:leukocyte (NLR) and platelet: leukocyte (PLR) ratios were calculated to evaluate the perioperative inflammatory status of both groups. Length of stay (LOS) and complications of both groups were also evaluated.


A total of 213 patients were included in the study—139 in the VO group and 74 in the TIVA group. No statistically significant differences were observed between the groups with regard to their postoperative inflammatory profiles, LOS, or complications by organ system; however, the incidence of renal complications was higher in the TIVA group (8.1 vs. 2.2 %) and approached statistical significance (p = 0.068).


In this retrospective study of patients undergoing CRS–HIPEC, the combined use of preoperative celecoxib, tramadol ER and pregabalin followed by intraoperative TIVA with infusions of propofol, dexmedetomidine, ketamine, and lidocaine was not associated with a reduction in LOS or complications by organ system. Postoperative NLR and PLR profiles were also not significantly impacted.


Celecoxib Tramadol Pregabalin Dexmedetomidine Epidural Analgesia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Pascal Owusu-Agyemang, Juan P. Cata, Keith F. Fournier, Acsa M. Zavala, Jose Soliz, Mike Hernandez, Andrea Hayes-Jordan, and Vijaya Gottumukkala have no conflicts of interest to declare.


This study was not funded.


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Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Pascal Owusu-Agyemang
    • 1
    Email author
  • Juan P. Cata
    • 1
    • 4
  • Keith F. Fournier
    • 2
  • Acsa M. Zavala
    • 1
  • Jose Soliz
    • 1
  • Mike Hernandez
    • 3
  • Andrea Hayes-Jordan
    • 2
  • Vijaya Gottumukkala
    • 1
  1. 1.Department of Anesthesiology and Perioperative MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Surgical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHoustonUSA
  4. 4.Anesthesiology and Surgical Oncology Research GroupHoustonUSA

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