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Intensive Care Management of Patient After Cytoreductive Surgery and HIPEC - A Concise Review

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Abstract

Hyperthermic intraperitoneal chemotherapy (HIPEC) in combination with cytoreductive surgery is a targeted treatment approach in which tumors that have spread through the lining of the abdomen are removed and then heated chemotherapy is perfused throughout the abdomen, with the intent of killing any remaining cancer cells that may be present after all the visible disease has been removed surgically. The chemotherapy is administered in high dosages to the targeted area and washed out, thereby limiting the systemic toxicity. The procedure usually takes 8 to 18 h and is most commonly used to treat appendiceal, colorectal or mesothelioma tumors including those that have failed standard chemotherapy and/or prior surgeries. Patients face major and life threatening derangements of their hemodynamic, respiratory and metabolic physiologic balance during the surgery and in the immediate postoperative period. Intensive monitoring and timely detection of possible complications and appropriate remedial action is crucial for better surgical results.

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References

  1. Raue W, Tsilimparis N, Langelotz C, et al. (2011) Initial results after implementation of a multimodal treatment for peritoneal malignancies. Acta Chir Belg 111:68–72

    CAS  PubMed  Google Scholar 

  2. Königsrainer I, Beckert S, Lehmann T, et al. (2011) Peritoneal carcinomatosis. Chirurg 82:375–380

    Article  PubMed  Google Scholar 

  3. Elias D, Lefevre JH, Chevalier J, et al. (2009) Complete cytoreductive surgery plus intraperitoneal chemohyperthermia with oxaliplatin for peritoneal carcinomatosis of colorectal origin. J Clin Oncol 27:681–685

    Article  PubMed  Google Scholar 

  4. Yan TD, Deraco M, Baratti D, et al. (2009) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma:multiinstitutional experience. J Clin Oncol 27:6237–6242

    Article  PubMed  Google Scholar 

  5. Verwaal VJ, Bruin S, Boot H, et al. (2008) 8-year follow-up of randomized trial: cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer. Ann Surg Oncol 15:2426–2432

    Article  PubMed  Google Scholar 

  6. Elias D, Gilly F, Boutitie F, et al. (2010) Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: retrospective analysis of 523 patients from a multicentric French study. J Clin Oncol 28:63–68

    Article  PubMed  Google Scholar 

  7. Esquivel J, Sticca R, Sugarbaker P, et al. (2007) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: a consensus statement. Ann Surg Oncol 14:128–133

    Article  CAS  PubMed  Google Scholar 

  8. Kanakoudis F, Petrou A, Michaloudis D, Chortaria G, Konstantinidou A (1996) Anaesthesia for intra-peritoneal perfusion of hyperthermic chemotherapy haemodynamic changes, oxygen consumption and delivery. Anaesthesia 51(11):1033–1036. doi:10.1111/j.1365-2044.1996.tb14998.x

    Article  CAS  PubMed  Google Scholar 

  9. Cooksley TJ, Haji-Michael P (2011) Post-operative critical care management of patients undergoing cytoreductive surgery and heated intraperitoneal chemotherapy (HIPEC). World J Surg Oncol 9:169. doi:10.1186/1477-7819-9-169

    Article  PubMed  PubMed Central  Google Scholar 

  10. Miao N, Pingpank JF, Alexander HR, Royal R, Steinberg SM, Quezado MM, Beresnev T, Quezado ZM (2009) Cytoreductive surgery and continuous hyperthermic peritoneal perfusion in patients with mesothelioma and peritoneal carcinomatosis: hemodynamic, metabolic, and anesthetic considerations. Ann Surg Oncol 16:334–344. doi:10.1245/s10434-008-0253-z

    Article  PubMed  PubMed Central  Google Scholar 

  11. Schmidt C, Creutzenberg M, Piso P, Hobbhahn J, Bucher M (2008) Peri-operative anaesthetic management of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Anaesthesia 63:389–395. doi:10.1111/j.1365-2044.2007.05380.x

    Article  CAS  PubMed  Google Scholar 

  12. Schmidt U, Dahlke MH, Klempnauer J, Schlitt HJ, Piso P (2005) Perioperative morbidity and quality of life in long-term survivors following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Eur J Surg Oncol 31:53–58. doi:10.1016/j.ejso.2004.09.011

    Article  CAS  PubMed  Google Scholar 

  13. Raue W, Tsilimparis N, Bloch A, Menenakos C, Hartmann J (2009) Volume therapy and cardiocircular function during hyperthermic intraperitoneal chemotherapy. Eur Surg Res 43:365–372. doi:10.1159/000248164

    Article  CAS  PubMed  Google Scholar 

  14. Tsiftsis D, De Bree E, Romanos J, Petrou A, Sanidas E, Askoxylakis J, Zervos K, Michaloudis D (1999) Peritoneal expansion by artificially produced ascites during perfusion chemotherapy. Arch Surg 134:545–549

    Article  CAS  PubMed  Google Scholar 

  15. Esquivel J, Angulo F, Bland RK, Stephens AD, Sugarbaker PH (2000) Hemodynamic and cardiac function parameters during heated intraoperative intraperitoneal chemotherapy using the open "coliseum technique". Ann Surg Oncol 7:296–300

    Article  CAS  PubMed  Google Scholar 

  16. Cafiero T, Di Iorio C, Di Minno RM, Sivolella G, Confuorto G (2006) Non-invasive cardiac monitoring by aortic blood flow determination in patients undergoing hyperthermic intraperitoneal intraoperative chemotherapy. Minerva Anestesiol 72:207–215

    CAS  PubMed  Google Scholar 

  17. Joshi GP (2005) Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery. Anesth Analg 101:601–605. doi:10.1213/01.ANE.0000159171.26521.31

    Article  PubMed  Google Scholar 

  18. Shime N, Lee M, Hatanaka T (1994) Cardiovascular changes during continuous hyperthermic peritoneal perfusion. Anesth Analg 78:938–942

    CAS  PubMed  Google Scholar 

  19. Schols SE, Lancé MD, Feijge MA, Damoiseaux J, Marcus MA, Hamulyák K, Ten Cate H, Heemskerk JW, van Pampus EC (2010) Impaired thrombin generation and fibrin clot formation in patients with dilutional coagulopathy during major surgery. Thromb Haemost 103:318–328. doi:10.1160/TH09-06-0396

    Article  CAS  PubMed  Google Scholar 

  20. Vorgias G, Iavazzo C, Mavromatis J, Leontara J, Katsoulis M, Kalinoglou N, Akrivos T (2007) Determination of the necessary total protein substitution requirements in patients with advanced stage ovarian cancer and ascites, undergoing debulking surgery. correlation with plasma proteins. Ann Surg Oncol 14:1919–1923. doi:10.1245/s10434-007-9404-x

    Article  PubMed  Google Scholar 

  21. De Somer F, Ceelen W, Delanghe J, De Smet D, Vanackere M, Pattyn P, Mortier E. Severe hyponatremia, hyperglycemia, and hyperlactatemia are associated with intraoperative hyperthermic intraperitoneal chemoperfusion with oxaliplatin. Perit Dial Int; 28:61–66

  22. Arakelian E, Gunningberg L, Larsson J, Norlén K, Mahteme H (2011) Factors influencing early postoperative recovery after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Eur J Surg Oncol 37:897–903. doi:10.1016/j.ejso.2011.06.003

    Article  CAS  PubMed  Google Scholar 

  23. ACE/ADA Task Force on Inpatient Diabetes.(2006) American College Of Endocrinology And American Diabetes Association concensus statement on inpatient diabetes and glycemic control: a call to action. Diabetes Care ; 29:1955–62.

  24. Clement S, Braithwaite SS, Magee MF, et al. (2004) Management Of Diabetes And Hyperglycemia in hospitals. Diabetes Care 27:553–591

    Article  PubMed  Google Scholar 

  25. Standards of Medical Care in Diabetes – 2011. American Diabetes Association. Diabetes Care 2011; 34:S11-61.

  26. Zielmann S, Grote R (1995) The effects of long-term sedation on intestinal function. Anaesthesist 44(Suppl 3):S549–S558

    CAS  PubMed  Google Scholar 

  27. Blumenthal S, Min K, NadigM, et al. (2005) Double epidural catheter with ropivacaine versus intravenous morphine: a comparison for postoperative analgesia after scoliosis correction surgery. Anesthesiology 102:175–180

    Article  CAS  PubMed  Google Scholar 

  28. De la Chapelle A, Pé rus O, Soubielle J, et al. (2005) High potential for epidural analgesia neuraxial block-associated hypotension in conjunction with heated intraoperative intraperitoneal chemotherapy. Reg Anesth Pain Med 30:313–314

    Article  PubMed  Google Scholar 

  29. Desgranges FP, Steghens A, Mithieux F, et al. (2010) Potential risks of thoracic epidural analgesia in hyperthermic intraperitoneal chemotherapy. J Surg Oncol 101:442

    PubMed  Google Scholar 

  30. Wulf H (1996) Epidural anaesthesia and spinal haematoma. Can J Anaesth 43:1260–1271

    Article  CAS  PubMed  Google Scholar 

  31. Peura DA, Johnson LF (1985) Cimetidine for prevention and treatment of gastroduodenal mucosal lesions in patients in an intensive care unit. Ann Int Med 103:173–177

    Article  CAS  PubMed  Google Scholar 

  32. Cook DJ, Fuller HD, Guyatt GH, et al. (1994) Risk factors for gastrointestinal bleeding in critically ill patients. N Engl J Med 330:377–381

    Article  CAS  PubMed  Google Scholar 

  33. Edmonds MJ, Crichton TJ, Runciman WB (2004) Evidence-based risk factors for postoperative deep vein thrombosis. ANZ J Surg 74:1082–1097

    Article  PubMed  Google Scholar 

  34. Kucher N, Tapson VF, Goldhaber SZ (2005) For the DVT FREE Steering Committee. Risk factors associated with symptomatic pulmonary embolism in a large cohort of deep vein thrombosis patients. Thromb Haemost 93:494–498

    CAS  PubMed  Google Scholar 

  35. Weimann A, Braga M, Harsanyi L, Laviano A, Ljungqvist O, Soeters P, Jauch KW, Kemen M, Hiesmayr JM, Horbach T, Kuse ER, Vestweber KH (2006) ESPEN guidelines on enteral nutrition: surgery including organ transplantation. Clin Nutr 25:224–244. doi:10.1016/j.clnu.2006.01.015

    Article  CAS  PubMed  Google Scholar 

  36. Dharmadhikari, Jagannath P, Shah R (2014) Initial experience with hyperthermic intra peritoneal chemotherapy and cytoreductivesurgery. Indian J Cancer 51(2):189–192

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Critical Care Medicine, Fortis Hospital, Bangalore, India

    A. V. Padmakumar

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  1. A. V. Padmakumar
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Correspondence to A. V. Padmakumar.

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Padmakumar, A.V. Intensive Care Management of Patient After Cytoreductive Surgery and HIPEC - A Concise Review. Indian J Surg Oncol 7, 244–248 (2016). https://doi.org/10.1007/s13193-016-0511-7

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  • DOI: https://doi.org/10.1007/s13193-016-0511-7

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