Anaesthetic management and perioperative outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: A retrospective analysis

Background and aims: Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is becoming the standard treatment option for peritoneal carcinomatosis but is associated with high rates of morbidity and mortality. Our aim was to retrospectively analyse and evaluate intra-operative factors associated with morbidity and mortality of CRS and HIPEC.

Methods: Intra-operative data were collected for cases done over 1 year (24 cases) and analysed for the primary outcome of post-operative ventilation >24 h, and secondary outcome of length of the Intensive Care Unit (ICU) stay >5 days. Statistical analysis was carried out in STATA 11 software.

Results: Higher peritoneal carcinoma index (PCI), (P = 0.0047), longer duration of surgery (P = 0.0016), higher delta temperatures (P = 0.0119), increased estimated blood loss (EBL) (P = 0.0054), high intraoperative fluid requirement (P = 0.0038), lower mean arterial pressure (MAP) (P = 0.0021) and higher blood products requirement were associated with >24 h ventilation. These factors were also associated with longer ICU stay. All these factors associated with >24 h ventilation and prolonged ICU stay are related to the PCI which is an indicator of the extent of surgery.

Conclusion: Higher PCI, longer duration of surgery, higher delta temperatures, increased EBL, high intraoperative fluid requirement, lower mean arterial pressure and higher blood products requirement were associated with >24 h postoperative ventilation as well as ICU stay >5 days. All these factors are related to the PCI, which is a major predictor of post-operative morbidity.