Anaesthetic management of patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei: a retrospective audit

Anaesth Intensive Care. 2017 Jul;45(4):490-498. doi: 10.1177/0310057X1704500413.

Abstract

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to improve quality of life and survival rates in patients suffering from pseudomyxoma peritonei. The procedure is long and associated with significant intraoperative blood loss. As such, the anaesthetic management of patients undergoing this procedure can be challenging. The aim of this paper is to describe our perioperative management of pseudomyxoma peritonei patients who received CRS and to report a retrospective audit of our outcomes and complications over a six-year period at a large tertiary centre. A total of 70 patients were included, of whom three (4.3%) had CRS alone, 42 (60.0%) had CRS with HIPEC, and 25 (35.7%) had CRS with HIPEC and early postoperative intraperitoneal chemotherapy. There were no intraoperative deaths. A total of four patients (5.7%) died during their hospital admission. At one-year follow-up, six patients (9.0%) had died, and at the end of the study 15 (22.4%) had died. No statistically significant difference in blood loss was seen between patients who received tranexamic acid (30 patients, 42.9%) and those who did not, but the incidence of deep venous thrombosis was much higher (10/30 versus 1/40). Different intravenous fluid strategies appeared not to influence the incidence of postoperative acute renal failure. Further research is required to evaluate the effects of intraoperative tranexamic acid and different intraoperative fluid strategies on outcomes in patients undergoing CRS with HIPEC.

Keywords: cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, pseudomyxoma peritonei, perioperative management, fluid therapy, tranexamic acid.

MeSH terms

  • Adult
  • Aged
  • Anesthesia / methods*
  • Antineoplastic Agents / administration & dosage*
  • Combined Modality Therapy
  • Cytoreduction Surgical Procedures / methods*
  • Female
  • Humans
  • Hyperthermia, Induced*
  • Injections, Intraperitoneal
  • Male
  • Middle Aged
  • Pseudomyxoma Peritonei / mortality
  • Pseudomyxoma Peritonei / surgery*
  • Retrospective Studies

Substances

  • Antineoplastic Agents