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Restrictive Intraoperative Fluid Rate is Associated with Improved Outcomes in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

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

Abstract

Background

Management of patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CS/HIPEC) has historically favored liberal fluid administration owing to lengthy duration of surgery and hyperthermia. This practice has been challenged in recent years with studies demonstrating improved outcomes with restrictive fluid administration.

Methods

Patients who underwent CS/HIPEC between March 2010 and September 2018 were included for analysis. Patients who received an above-median fluid rate (high-IVF) versus below-median fluid rate (low-IVF) were compared, and multivariate analyses were performed for length of stay, 90-day unplanned readmissions, and major complications.

Results

The 167 patients had a mean age of 56.7 ± 11.4 years and body mass index of 29.5 ± 6.9 kg/m2. The median rate of total intraoperative crystalloid and colloid was 7.4 mL/kg/h. The low-IVF group had less blood loss (183 vs. 330 mL, p = 0.002), were less likely to need intraoperative vasopressor drip (2.4% vs. 11.9%, p = 0.018), and experienced fewer cardiac complications (2.4% vs. 10.7%, p = 0.031), pneumonias (0% vs. 6.0%, p = 0.024), and Clavien–Dindo grade 3–5 complications (14.5% vs. 33.3%, p = 0.004). Multivariate analyses identified bowel resection (HR 4.65, p = 0.0008) as a risk factor for 90-day unplanned readmission, while bowel resection, intraoperative fluid rate, and estimated blood loss were associated with increased length of stay.

Conclusion

Higher intraoperative fluid intake was associated with multiple postoperative complications and increased length of stay, and represents a potentially avoidable risk factor for morbidity in CS/HIPEC.

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Acknowledgments

None.

Funding

This work was supported by National Cancer Institute (NCI) Grant P30 CA016056.

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Authors and Affiliations

  1. Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA

    June S. Peng MD, Joseph J. Skitzki MD, John M. Kane III MD & Valerie A. Francescutti MD, MSc

  2. Division of Surgical Oncology, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA

    June S. Peng MD

  3. Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA

    Jessica LaPiano MD

  4. Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA

    Katy Wang MA & Kristopher Attwood PhD

  5. Department of Surgery, McMaster University, Hamilton, ON, Canada

    Valerie A. Francescutti MD, MSc

Authors
  1. June S. Peng MD
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  2. Jessica LaPiano MD
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  3. Katy Wang MA
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  4. Kristopher Attwood PhD
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  5. Joseph J. Skitzki MD
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  6. John M. Kane III MD
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  7. Valerie A. Francescutti MD, MSc
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Contributions

J.S.P., K.W., K.A., and V.A.F. had access to all data in this study and take full responsibility for the integrity of the data and accuracy of the analysis. Study concept and design: all authors. Acquisition of data: J.S.P., J.L. Analysis and interpretation of the data: J.S.P., K.W., K.A., V.A.F. Drafting and manuscript: J.S.P., V.A.F. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: K.W., K.A.

Corresponding author

Correspondence to June S. Peng MD.

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V.F., Consultant for Novartis. No other disclosures were reported.

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Peng, J.S., LaPiano, J., Wang, K. et al. Restrictive Intraoperative Fluid Rate is Associated with Improved Outcomes in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 29, 163–173 (2022). https://doi.org/10.1245/s10434-021-10556-3

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  • DOI: https://doi.org/10.1245/s10434-021-10556-3

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