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Perioperative Management of Patients Undergoing Cytoreductive Surgery Combined with Heated Intraperitoneal Chemotherapy for Peritoneal Surface Malignancy: A Multi-Institutional Experience

  • Gastrointestinal Oncology
  • Published:
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Abstract

Background

Cytoreductive surgery (CRS) combined with heated intraperitoneal chemotherapy (HIPEC) is an established treatment for patients with pseudomyxoma peritonei. There is now increasing evidence for the use of CRS and HIPEC in the treatment of other peritoneal surface malignancies. There is currently no consensus on the perioperative management of this patient group.

Methods

An international survey of practice was conducted using an online survey tool. Centers were identified from the list of delegates attending the Seventh International Workshop on Peritoneal Surface malignancy held in Uppsala, Sweden, in September 2010.

Results

Fully completed surveys were received from 29 of 41 identified centers (71 %). The survey covers the combined experience amassed by anesthesiologists caring for 8,467 patients undergoing cytoreductive surgery. Intraoperative fluid management, management of coagulopathy, management of the HIPEC phase of the operation, and postoperative analgesia caused the greatest difficulties for the anesthesia team with variation in management identified between different institutions. The incidence of epidural abscess in this patient group was found to be 1:2,139.

Conclusions

Optimal preoperative, intraoperative, and postoperative care is crucial to diminish the complications in this complex treatment strategy. Multicenter collaboration is suggested to gain evidence on the best strategies for perioperative management. Further data collection needs to be undertaken to assess the safety of epidural anesthesia in this patient group.

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References

  1. Moran B, Baratti D, Yan TD, Kusamura S, Deraco M. Consensus statement on the loco-regional treatment of appendiceal mucinous neoplasms with peritoneal dissemination (pseudomyxoma peritonei). J Surg Oncol. 2008;98:277–82.

    Article  PubMed  Google Scholar 

  2. Bevan KE, Mohamed F, Moran BJ. Pseudomyxoma peritonei. World J Gastrointest Oncol. 2010;2:44–50.

    Article  PubMed  Google Scholar 

  3. Esquivel J, Sticca R, Sugarbaker P, Levine E, Yan TD, Alexander R, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: a consensus statement. Ann Surg Oncol. 2007;14:128–33.

    PubMed  CAS  Google Scholar 

  4. Deraco M, Baratti D, Laterza B, Balestra MR, Mingrone E, Macri A, et al. Advanced cytoreduction as surgical standard of care and hyperthermic intraperitoneal chemotherapy as promising treatment in epithelial ovarian cancer. Eur J Surg Oncol. 2011;37:4–9.

    Article  PubMed  CAS  Google Scholar 

  5. Mohamed F, Moran BJ. Morbidity and mortality with cytoreductive surgery and intraperitoneal chemotherapy: the importance of a learning curve. Cancer J. 2009;15:196–9.

    Article  PubMed  Google Scholar 

  6. Moran BJ. Decision-making and technical factors account for the learning curve in complex surgery. J Public Health (Oxf). 2006;28:375–8.

    Article  CAS  Google Scholar 

  7. Smeenk RM, Verwaal VJ, Zoetmulder FA. Learning curve of combined modality treatment in peritoneal surface disease. Br J Surg. 2007;94:1408–14.

    Article  PubMed  CAS  Google Scholar 

  8. Yan TD, Links M, Fransi S, Jacques T, Black D, Saunders V, et al. Learning curve for cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal surface malignancy—a journey to becoming a Nationally Funded Peritonectomy Center. Ann Surg Oncol. 2007;14:2270–80.

    Article  PubMed  Google Scholar 

  9. Bartlett DL. HIPEC: the complexities of clinical trials. Ann Surg Oncol. 2008;15:1277–9.

    Article  PubMed  Google Scholar 

  10. Behera M, Kumar A, Soares HP, Sokol L, Djulbegovic B. .Evidence-based medicine for rare diseases: implications for data interpretation and clinical trial design. Cancer Control. 2007;14:160–6.

    PubMed  Google Scholar 

  11. Mythen MG, Webb AR. Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery. Arch Surg. 1995;130:423–9.

    Article  PubMed  CAS  Google Scholar 

  12. Raue W, Tsilimparis N, Bloch A. Volume therapy and cardiocircular function during hyperthermic intraperitoneal chemotherapy. Eur Surg Res. 2009;43:365–72.

    Article  PubMed  CAS  Google Scholar 

  13. Yan T, Black D, Savady R, Sugarbaker P. A systematic review on the efficacy of cytoreductive surgery and perioperative intraperitoneal chemotherapy for pseudomyxoma peritonei. Ann Surg Oncol. 2006;14:484–92.

    Article  PubMed  Google Scholar 

  14. Kumar A, Anel R, Bunnell E. Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume, cardiac performance, or the response to volume infusion in normal subjects. Crit Care Med. 2004;32:691–9.

    Article  PubMed  Google Scholar 

  15. Marik PE, Baram M, Vahid Bl. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008;134:172–8.

    Article  PubMed  Google Scholar 

  16. Brandstrup B, Tonnesen H, Beier-Holgersen R, Hjortso E, Ording H, Lindorff-Larsen K, et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens, a randomized assessor-blinded multicenter trial. Ann Surg. 2003;238:641–8.

    Article  PubMed  Google Scholar 

  17. Nisanevich V, Felsenstein I, Almogy G, Weissman C, Einav S, Matot I. Effect of intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology. 2005;103:25–32.

    Article  PubMed  Google Scholar 

  18. Grocott M, Mythen M, Gan T. Perioperative fluid management and clinical outcomes in adults. Anesth Analg. 2005;100:1093–106.

    Article  PubMed  Google Scholar 

  19. Wakeling HG, McFall MR, Jenkins CS, Woods WG, Miles WF, Barclay GR, et al. Intraoperative oesophageal Doppler guided fluid management shortens postoperative hospital stay after major bowel surgery. Br J Anaesth. 2005;95:634–42.

    Article  PubMed  CAS  Google Scholar 

  20. Giglio M, Marucci M, Testini M, Brienza N. Goal-directed haemodynamic therapy and gastrointestinal complications in major surgery: a meta-analysis of randomized controlled trials. Br J Anaesth. 2009;103:637–46.

    Article  PubMed  CAS  Google Scholar 

  21. Tote S, Grounds R. Performing perioperative optimization of the high risk surgical patient. Br J Anaesth. 2006;97:4–11.

    Article  PubMed  CAS  Google Scholar 

  22. Venn R, Steele A, Richardson P, Poloniecki J, Grounds M, Newman P. Randomized controlled trial to investigate influence of the fluid challenge on duration of hospital stay and perioperative morbidity in patients with hip fractures. Br J Anaesth. 2002;88:65–71.

    Article  PubMed  CAS  Google Scholar 

  23. Powell-Tuck J, Gosling P, Lobo DN, Allison SP, Carlson GL, Gore, M, et al. British Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients GIFTASUP 2010.

  24. Jonas M, Fennell J, Brudney CS. Haemodynamic optimisation of the surgical patient revisited. Anaesthesia Int. 2008;2.

  25. Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med. 1999;340:410–7.

    Article  Google Scholar 

  26. Schmidt C, Creutzenberg M, Piso P, Hobbhahn J. Bucher M. Peri-operative anaesthetic management of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Anaesthesia. 2008;63:389–95.

    Article  PubMed  CAS  Google Scholar 

  27. Boldt J. Use of albumin: an update. Br J Anaesth. 2010;104:276–84.

    Article  PubMed  CAS  Google Scholar 

  28. The SAFE Study Investigators. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004;350: 2247–56.

    Article  Google Scholar 

  29. Dubois MJ, Orellana-Jimenez C, Melot C, De Backer D, Berre J, Leeman M, et al. Albumin administration improves organ function in critically ill hypoalbuminemic patients: A prospective, randomized, controlled, pilot study. Crit Care Med. 2006;34:2536–40.

    Article  PubMed  CAS  Google Scholar 

  30. Yuan XY, Zhang CH, He YL, Yuan YX, Cai SR, Luo NX, et al. Is albumin administration beneficial in early stage of postoperative hypoalbuminemia following gastrointestinal surgery? A prospective randomized controlled trial. Am J Surg. 2008;196:751–5.

    Article  PubMed  CAS  Google Scholar 

  31. Schmidt C, Moritz S, Rath S, Grossmann E, Wiesenack C, Piso P, et al. Perioperative management of patients with cytoreductive surgery for peritoneal carcinomatosis. J Surg Oncol. 2009;100:297–301.

    Article  PubMed  CAS  Google Scholar 

  32. Brohi K, Cohen MJ, Ganter MT, Schultz MJ, Levi M, Mackersie RC, et al. Acute coagulopathy of trauma: hypoperfusion induces systemic anticoagulation and hyperfibrinolysis. J Trauma. 2008;64:1211–7.

    Article  PubMed  Google Scholar 

  33. Dedrick RL. Theoretical and experimental bases of intraperitoneal chemotherapy. Semin Oncol. 1985;12:1–6.

    PubMed  CAS  Google Scholar 

  34. Gilly FN, Carry PY, Sayag AC, Brachet A, Panteix G, Salle B, et al. Regional chemotherapy (with mitomycin C) and intra-operative hyperthermia for digestive cancers with peritoneal carcinomatosis. Hepatogastroenterology. 1994;41:124–9.

    PubMed  CAS  Google Scholar 

  35. Glehen O, Beaujard AC, Arvieux C, Huber O, Gilly FN. Peritoneal carcinomatosis. Surgical treatment, peritonectomy and intraperitoneal chemohyperthermia. Gastroenterol Clin Biol. 2002;26:210–5.

    PubMed  Google Scholar 

  36. Sugarbaker PH. Intraperitoneal chemotherapy and cytoreductive surgery for the prevention and treatment of peritoneal carcinomatosis and sarcomatosis. Semin Surg Oncol. 1998;14:254–61.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  38. Cafiero T, Di Iorio C, Di Minno RM, Sivolella G, Confuorto G. Non-invasive cardiac monitoring by aortic blood flow determination in patients undergoing hyperthermic intraperitoneal intraoperative chemotherapy. Minerva Anestesiol. 2006;72:207–15.

    PubMed  CAS  Google Scholar 

  39. Celeen W, Peeters M, Houtmeyers C, Breusegem C, De Somer F, Pattyn P. Safety and efficacy of hyperthermic intraperitoneal chemoperfusion with high dose oxaliplatin in patients with peritoneal carcinomatosis. Ann Surg Oncol. 15;2:535–41.

  40. Nair RL, Tobias J, Stemmerman G, Lowy AM. Cerebral edema in a patient following cytoreductive and hyperthermic intraoperative intraperitoneal chemoperfusion. World J Surg Oncol. 2006;4:85.

    Article  PubMed  Google Scholar 

  41. Raft J, Parisot M, Marchal F, Tala S, Desandes E, Lalot JM, et al. Impact of the hyperthermic intraperitoneal chemotherapy on the fluid-electrolyte changes and on the acid-base balance. Anna Fr Anesth Reanim. 2010;29:676–81.

    Article  CAS  Google Scholar 

  42. Verwaal VJ, van Tinteren H, van Ruth SV, Zoetmulder FA. Toxicity of cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy. J Surg Oncol. 2004;85:61–7.

    Article  PubMed  Google Scholar 

  43. Desgranges F-P, Steghens A, Mithieux F, Rosay H. Potential risks of thoracic epidural analgesia in hyperthermic intraperitoneal chemotherapy. J Surg Oncol. 2010;101:442.

    PubMed  Google Scholar 

  44. Schmidt C, Steinke T, Moritz S, Bucher M. Thoracic epidural anesthesia in patients with cytoreductive surgery and HIPEC. J Surg Oncol. 2010;102:545–6.

    Article  PubMed  CAS  Google Scholar 

  45. Cook TM, Counsell D, Wildsmith JA; Royal College of Anaesthetists Third National Audit Project. Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists. Br J Anaesth. 2009;102:179–90.

    Article  PubMed  CAS  Google Scholar 

  46. Murphy EM, Sexton R, Moran BJ. Early results of surgery in 123 patients with pseudomyxoma peritonei from a perforated appendiceal neoplasm. Dis Colon Rectum. 2007;50:37–42.

    Article  PubMed  Google Scholar 

  47. European Community Directive 2000/34/EC of the European Parliament and of the Council. OJEC. 2000;L195:41.

    Google Scholar 

  48. Bartel P, Offermeier W, Smith F, Becker P. Attention and working memory in resident anaesthetists after night duty: group and individual effects. Occup Environ Med. 2004;612:167–70.

    Article  Google Scholar 

  49. Williamson AM, Feyer AM. Moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication. Occup Environ Med. 2000;57:649–55.

    Article  PubMed  CAS  Google Scholar 

  50. Youssef H, Newman C, Chandrakumaran K, Mohamed F, Cecil TD, Moran BJ. Operative findings, early complications, and long-term survival in 456 patients with pseudomyxoma peritonei syndrome of appendiceal origin. Dis Colon Rectum. 2011;54:293–9.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. National Centre for Pseudomyxoma Surgery, Basingstoke and North Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK

    John C. Bell FRCA, FFICM, Barnaby G. Rylah FRCA, MRCP, Robert W. Chambers FRCA, Helen Peet FRCA, MRCP, Faheez Mohamed MD, FRCS & Brendan J. Moran MCH, FRCS

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  1. John C. Bell FRCA, FFICM
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  2. Barnaby G. Rylah FRCA, MRCP
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  3. Robert W. Chambers FRCA
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  4. Helen Peet FRCA, MRCP
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  5. Faheez Mohamed MD, FRCS
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  6. Brendan J. Moran MCH, FRCS
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Correspondence to John C. Bell FRCA, FFICM.

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Bell, J.C., Rylah, B.G., Chambers, R.W. et al. Perioperative Management of Patients Undergoing Cytoreductive Surgery Combined with Heated Intraperitoneal Chemotherapy for Peritoneal Surface Malignancy: A Multi-Institutional Experience. Ann Surg Oncol 19, 4244–4251 (2012). https://doi.org/10.1245/s10434-012-2496-y

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