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Standard Operating Procedures for Anesthesia Management in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Improve Patient Outcomes: A Patient Cohort Analysis

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

Abstract

Background

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) offer survival benefits in well-selected patients with peritoneal tumors. The complexity of CRS/HIPEC requires surgical specialization. In contrast, limited data are available regarding the impact of anesthesia management. We assessed the role of standard operating procedures (SOPs) for anesthesia on perioperative patient outcomes after CRS/HIPEC.

Methods

Between 2009 and 2015, 112 CRS/HIPEC were performed at the University Hospital of Zurich. Procedures were grouped in an “early or late” group before (n = 57) and after (n = 55) the introduction of SOPs, which defined management of fluids, serum albumin, hemostasis, and body temperature.

Results

Introduction of SOPs significantly changed patient management. Patients received in total less colloids (p = 0.03) and less diuretics (p = 0.007). We noticed an increased substitution of albumin (p = 0.001) and coagulation factors (p = 0.008). Body temperatures were higher at the end of the operation (p = 0.005), and more patients were extubated in the operating room (66% vs. 42%, p = 0.02). The rate of major complications (p = 0.003) and reoperations (p = 0.01) was reduced after the introduction of SOPs. On multivariate analysis, two independent prognostic factors were identified. The use of > 2000 mL of colloids [odds ratio (OR) 5.31 (1.06–26.56), p = 0.042] was associated with major morbidity. In contrast, substitution of albumin [OR 0.12 (0.01–0.96), p = 0.046] was associated with better outcomes.

Conclusions

SOPs for perioperative anesthesia management have a major impact on outcomes of patients after CRS/HIPEC. Management of colloid administration was an independent prognostic factor for perioperative outcomes. This highlights the role of the anesthesiologist and the need for specialization beyond the surgical team.

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Authors and Affiliations

  1. Department of Visceral Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland

    Dominique Fichmann MMed, Lilian Roth MD, Dimitri A. Raptis MD, PhD, Philippe Gertsch MD, René Vonlanthen MD, MHA, Olivier de Rougemont MD & Kuno Lehmann MD, PhD

  2. Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland

    Marie-Elisabeth Kajdi MD, Julio Moral MD & Beatrice Beck-Schimmer MD

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  1. Dominique Fichmann MMed
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  2. Lilian Roth MD
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  4. Marie-Elisabeth Kajdi MD
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Correspondence to Kuno Lehmann MD, PhD.

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Fichmann, D., Roth, L., Raptis, D.A. et al. Standard Operating Procedures for Anesthesia Management in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Improve Patient Outcomes: A Patient Cohort Analysis. Ann Surg Oncol 26, 3652–3662 (2019). https://doi.org/10.1245/s10434-019-07644-w

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  • DOI: https://doi.org/10.1245/s10434-019-07644-w

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