Skip to main content

Dextrose-Containing Carrier Solution for Hyperthermic Intraperitoneal Chemotherapy: Increased Intraoperative Hyperglycemia and Postoperative Complications

Abstract

Purpose

Intraoperative hyperglycemia is associated with infectious complications in general surgery patients. This study aimed to determine if the use of lactated Ringer’s (LR) carrier solution during hyperthermic intraperitoneal chemotherapy (HIPEC) would lower the incidence of intraoperative hyperglycemia and improve postoperative outcomes when compared with a standard 1.5% dextrose peritoneal dialysate carrier solution.

Patients and Methods

This is a retrospective cohort study of 134 patients who underwent HIPEC at the University of Colorado. Perioperative glucose levels and outcomes were compared between patients who were perfused with 1.5% dextrose peritoneal dialysate carrier solution (n = 68) versus LR carrier solution (n = 66).

Results

The study population consisted of patients undergoing HIPEC for appendiceal (50%), colorectal (34%), mesothelioma (8%), and ovarian cancer (5%). Intraoperative severe hyperglycemia (glucose ≥ 180 mg/dL) was significantly more common among patients perfused with a dextrose-containing carrier solution versus those perfused with LR (88% vs. 21%; p < 0.001). Patients in the dextrose cohort had significantly more severe complications (39% vs. 12%; p = 0.034), infectious complications (35% vs. 15%; p = 0.011), and organ space infections (18% vs. 5%: p = 0.026) than the LR cohort. On multivariable analysis, dextrose-containing carrier solution was significantly associated with an increased risk of postoperative infectious complications (HR 5.16; p = 0.006).

Conclusions

Intraoperative hyperglycemia is common when dextrose-containing carrier solution is used during HIPEC, and severe intraoperative hyperglycemia is strongly associated with an increased risk for infectious of complications following HIPEC. LR carrier solution should be routinely used to reduce intraoperative hyperglycemia and its associated risks.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. Rueth NM, Murray SE, Huddleston SJ, et al. Severe electrolyte disturbances after hyperthermic intraperitoneal chemotherapy: oxaliplatin versus mitomycin C. Ann Surg Oncol. 2011;18(1):174–180.

    Article  Google Scholar 

  2. Stewart CL, Gleisner A, Halpern A, et al. Implications of hyperthermic intraperitoneal chemotherapy perfusion-related hyperglycemia. Ann Surg Oncol. 2018;25(3):655–659.

    Article  Google Scholar 

  3. Mizock BA. Alterations in carbohydrate metabolism during stress: a review of the literature. Am J Med. 1995;98(1):75–84.

    CAS  Article  Google Scholar 

  4. Kwoun MO, Ling PR, Lydon E, et al. Immunologic effects of acute hyperglycemia in nondiabetic rats. JPEN. 1997;21(2):91–95.

    CAS  Article  Google Scholar 

  5. Turina M, Fry DE, Polk HC, Jr. Acute hyperglycemia and the innate immune system: clinical, cellular, and molecular aspects. Crit Care Med. 2005;33(7):1624–1633.

    Article  Google Scholar 

  6. Doenst T, Wijeysundera D, Karkouti K, et al. Hyperglycemia during cardiopulmonary bypass is an independent risk factor for mortality in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg. 2005;130(4):1144.

    Article  Google Scholar 

  7. Kwon S, Thompson R, Dellinger P, Yanez D, Farrohki E, Flum D. Importance of perioperative glycemic control in general surgery: a report from the Surgical Care and Outcomes Assessment Program. Ann Surg. 2013;257(1):8–14.

    Article  Google Scholar 

  8. Shanks AM, Woodrum DT, Kumar SS, Campbell DA, Jr., Kheterpal S. Intraoperative hyperglycemia is independently associated with infectious complications after non-cardiac surgery. BMC Anesthesiol. 2018;18(1):90.

    Article  Google Scholar 

  9. Stewart CL, McCarter M. ASO Author Reflections: Should we be using dextrose-containing carrier solutions for perfusion during HIPEC? Ann Surg Oncol. 2018;25(Suppl 3):834–835.

    Article  Google Scholar 

  10. 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):1501–1505.

    CAS  Article  Google Scholar 

  11. Kusamura S, Dominique E, Baratti D, Younan R, Deraco M. Drugs, carrier solutions and temperature in hyperthermic intraperitoneal chemotherapy. J Surg Oncol. 2008;98(4):247–252.

    Article  Google Scholar 

  12. Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–213.

    Article  Google Scholar 

  13. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51(6):1173–1182.

    CAS  Article  Google Scholar 

  14. Yurttas C, Hoffmann G, Tolios A, et al. Systematic review of variations in hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal metastasis from colorectal cancer. J Clin Med. 2018;7(12):567.

    Article  Google Scholar 

  15. Bargman JM. Advances in peritoneal dialysis: a review. Semin Dial. 2012;25(5):545–549.

    Article  Google Scholar 

  16. Sugarbaker PH, Stuart OA, Carmignani CP. Pharmacokinetic changes induced by the volume of chemotherapy solution in patients treated with hyperthermic intraperitoneal mitomycin C. Cancer Chemother Pharmacol. 2006;57(5):703–708.

    CAS  Article  Google Scholar 

  17. Jacquet P, Stephens AD, Averbach AM, et al. Analysis of morbidity and mortality in 60 patients with peritoneal carcinomatosis treated by cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy. Cancer. 1996;77(12):2622–2629.

    CAS  Article  Google Scholar 

  18. Mehta AM, Van den Hoven JM, Rosing H, et al. Stability of oxaliplatin in chloride-containing carrier solutions used in hyperthermic intraperitoneal chemotherapy. Int J Pharm. 2015;479(1):23–27.

    CAS  Article  Google Scholar 

  19. Mehta AM, Huitema AD, Burger JW, Brandt-Kerkhof AR, van den Heuvel SF, Verwaal VJ. Standard clinical protocol for didirectional hyperthermic intraperitoneal chemotherapy (HIPEC): systemic leucovorin, 5-fluorouracil, and heated intraperitoneal oxaliplatin in a chloride-containing carrier solution. Ann Surg Oncol. 2017;24(4):990–997.

    Article  Google Scholar 

  20. Benvenuto JA, Anderson RW, Kerkof K, Smith RG, Loo TL. Stability and compatibility of antitumor agents in glass and plastic containers. Am J Hosp Pharm. 1981;38(12):1914–1918.

    CAS  PubMed  Google Scholar 

  21. Myers AL, Zhang Y-P, Kawedia JD, et al. Solubilization and stability of mitomycin C solutions prepared for intravesical administration. Drugs R&D. 2017;17(2):297–304.

    CAS  Article  Google Scholar 

  22. Polanco PM, Ding Y, Knox JM, et al. Institutional learning curve of cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion for peritoneal malignancies. Ann Surg Oncol. 2015;22(5):1673–1679.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Steven A. Ahrendt MD.

Ethics declarations

Disclosures

The authors declare no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Torphy, R.J., Stewart, C., Sharma, P. et al. Dextrose-Containing Carrier Solution for Hyperthermic Intraperitoneal Chemotherapy: Increased Intraoperative Hyperglycemia and Postoperative Complications. Ann Surg Oncol 27, 4874–4882 (2020). https://doi.org/10.1245/s10434-020-08330-y

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-020-08330-y