Perioperative Management of Patients Undergoing CRS and HIPEC

Akhil Chawla1, Cheng-Cheng Zhu2, Grant Backer3, Julia O’Gara3, Zhi ven Fong3, Hao M Deng2, Xiaodong Bao2, James C Cusack3*

1Department of Surgery, Division of Surgical Oncology, Northwestern University Feinberg School of Medicine, USA
2Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, USA
3Department of Surgery, Division of Surgical Oncology, Massachusetts General Hospital, USA

^*Correspondance to: James C. Cusack 

 PDF  Full Text DOI: 10.25107/2474-1647.2788

Abstract

Background and Objectives: We conducted a retrospective review to assess the outcomes of our initial five-year experience of Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) at the Massachusetts General Hospital. Methods: A prospective database was maintained to understand the effect of our multidisciplinary approach using a dedicated perioperative anesthesia and nursing team and goal-directed fluidrestrictive resuscitation for CRS and HIPEC performed with 40 mg of mitomycin C at 42°C for 90 min. ERAS protocol included strict fluid-replacement guidelines, early ambulation, and early resumption of enteral intake. Results: We performed 97 cases from 2011-2016. The median PCI was 14.5. Completeness of Cytoreduction score was 0 or 1 in 88.5%. Patients had a median estimated blood loss of 300 mL with a transfusion requirement in 14.4% of patients. 88.7% of patients were extubated immediately postoperatively. The intraoperative complication rate was 4.1%. The median ICU and hospital stays were 2 and 8 days, respectively. The 30-day readmission rate was 16.5%. The 90-day mortality rate was 0%. Conclusion: The outcomes from our initial experience using a multidisciplinary approach in patients undergoing CRS and HIPEC demonstrate short postoperative ICU and hospital stays, acceptable postoperative morbidity and readmission rates, and low perioperative mortality.

Keywords

Cytoreductive surgery; Hyperthermic intraperitoneal chemotherapy; Pseudomyxoma peritonei; Enhanced recovery after surgery

Cite the article

Chawla A, Zhu C-C, Backer G, O'Gara J, Fong ZV,Deng H, Bao X, Cusack J. Perioperative Management of Patients Undergoing CRS and HIPEC. Clin Surg. 2020; 5: 2788.