The perioperative course and anesthetic challenge for cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

Background
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) by the closed technique provide a promising therapeutic option for highly selected patients with peritoneal carcinomatosis. CRS with HIPEC is a long and complex procedure with significant blood and fluid loss, hemodynamic, hematological, and metabolic alterations in the perioperative period, with resultant morbidity and mortality. This work was done to evaluate our early experience in anesthesia and early postoperative care for these cases.
Patients and methods
This retrospective study was done on 13 patients for CRS and HIPEC, with intraoperative and early postoperative recording and evaluation of the fluid and blood losses and replacement, changes in hemodynamic, metabolic, and respiratory parameters and any complications happened.
Results
Our data demonstrated high fluid and blood losses during CRS. During HIPEC, raised body temperature, increased central venous pressure and airway pressure, increased arterial partial carbon dioxide tension (PaCO), decreased ratio of arterial oxygen partial pressure/fractional inspired oxygen (O/O), and increased serum lactate were recorded. These were associated with hemodynamic, metabolic, and respiratory acidosis. The patients were continuing resuscitation and correction of any derangements in intensive care unit.
Conclusion
CRS and HIPEC have become standard treatment for certain peritoneal surface malignancies. This extended surgery is considered a challenge for the anesthetist. It is associated with relevant fluid, blood, and protein losses, together with hemodynamic, respiratory, and metabolic derangements. However, these derangements are short lived and could be controlled by continuous monitoring and rapid intervention.