Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy
In a single-center experience reported in JAMA Surgery, Eng et al found that an increased intraoperative fluid rate was associated with increased perioperative morbidity in patients with peritoneal cancer undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.
Study Details
The retrospective analysis included 133 patients with primary or secondary cancers treated between April 2009 and June 2016 at City of Hope National Medical Center. Morbidity associated with intraoperative fluid management was determined using the comprehensive complication index, which combines all perioperative complications and severities into a continuous variable from 0 to 100 in each patient.
Patients had a mean age of 54 years; 38% and 37% had metastatic appendiceal and colorectal cancers, respectively. Mitomycin and platinum-based chemotherapy were used in 72% and 28% of patients, respectively.
Association With Morbidity
The mean intraoperative fluid rate was 15.7 mL/kg/h. The mean comprehensive complication index was 26.0. On multivariate analysis, age (coefficient = 0.32, P = .04), intraoperative fluid rate (coefficient = 0.97, P = .02), and estimated blood loss (coefficient = 0.02, P = .002) were independent predictors of an increased comprehensive complication index. The comprehensive complication index was 43% higher among patients receiving intraoperative fluid rate above the mean vs below the mean (31.5 vs 22.0, P = .02).
The investigators concluded: “Intraoperative fluid administration is associated with a significant increase in perioperative morbidity in patients undergoing [cytoreductive surgery with hyperthermic intraperitoneal chemotherapy]. Fluid administration protocols that include standardized restrictive fluid rates can potentially help to mitigate morbidity in patients undergoing [cytoreductive surgery with hyperthermic intraperitoneal chemotherapy].”
Byrne Lee, MD, of the Department of Surgery, City of Hope National Medical Center, is the corresponding author of the JAMA Surgery article.
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