title: Alterations in hemostasis during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with peritoneal carcinomatosis.
abstract: BACKGROUND
  Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) is frequently associated with coagulation impairment and perioperative blood transfusion. Our aim was to investigate the impact of each procedure step on hemostasis, as measured by rotational thromboelastometry™ (ROTEM), fibrinogen level and platelet count as a primary outcome, along with its relationship with transfusion needs.
  
  
  METHODS
  A prospective longitudinal study was performed. Hemoglobin level, fibrinogen level, platelet count and ROTEM parameters: clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF), α-angle (EXTEM, INTEM, FIBTEM) were measured before the procedure, at the end of cytoreductive surgery and after HIPEC. Appropriate statistical tests were used for comparison. A P<.05 was considered as significant.
  
  
  RESULTS
  Forty-one women, with median age 54 (range 34-76) were recruited. Cytoreductive surgery was followed by a reduction of hemoglobin level from 11,4±1,5g/dl to 10,6±1,6g/dl, a reduction of serum fibrinogen level from 269±69mg/dl to 230±48mg/dl (P<.01) and MCF decline from 20±10 to 16±8mm (P<.01), in the FIBTEM test. HIPEC was followed by no hemostatic impairment. The number of packed red blood cells administered during patients stay kept a mild significant relationship with both fibrinogen level (ρ = -0.5, P=.002), and MCF EXTEM values (ρ= -0.43, P=0.006), recorded after HIPEC.
  
  
  CONCLUSIONS
  The mild observed hemostatic impairment appeared after cytoreductive surgery instead of HIPEC, involving surgical hemorrhage as the most likely responsible factor. Further studies are required to confirm a correlation between transfusion needs and postoperative hemostatic tests.
authors.affiliation: Servicio de Anestesia, Hospital Universitario Virgen de la Arrixaca, Murcia, España.
authors.forename: Luis
authors.initials: L
authors.lastname: Falcón Araña
authors.affiliation: Servicio de Anestesia, Hospital Universitario Virgen de la Arrixaca, Murcia, España. Electronic address: smart10015@hotmail.com.
authors.forename: Diego
authors.initials: D
authors.lastname: Fuentes-García
authors.affiliation: Departamento de Cirugía, Hospital Universitario Virgen de la Arrixaca, Murcia, España.
authors.forename: María José
authors.initials: MJ
authors.lastname: Roca Calvo
authors.affiliation: Servicio de Anestesia, Hospital Universitario Virgen de la Arrixaca, Murcia, España.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Hernández-Palazón
authors.affiliation: Departamento de Cirugía, Hospital Universitario Virgen de la Arrixaca, Murcia, España.
authors.forename: José
authors.initials: J
authors.lastname: Gil Martínez
authors.affiliation: Departamento de Cirugía, Hospital Universitario Virgen de la Arrixaca, Murcia, España.
authors.forename: Pedro Antonio
authors.initials: PA
authors.lastname: Cascales Campos
authors.affiliation: Servicio de Anestesia, Hospital Universitario Virgen de la Arrixaca, Murcia, España.
authors.forename: Francisco José
authors.initials: FJ
authors.lastname: Acosta Villegas
authors.affiliation: Departamento de Cirugía, Hospital Universitario Virgen de la Arrixaca, Murcia, España.
authors.forename: Pascual
authors.initials: P
authors.lastname: Parrilla Paricio
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures; D005260:Female; D006487:Hemostasis; D006801:Humans; D006979:Hyperthermia, Induced; D007263:Infusions, Parenteral; D008137:Longitudinal Studies; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies
keywords: Blood transfusion; Carcinomatosis peritoneal; Cirugía citorreductora; Cytoreductive surgery; Hemostasia; Hemostasis; Hyperthermic intraperitoneal chemotherapy; Metástasis peritoneal; Peritoneal carcinomatosis; Peritoneal metastasis; Quimioterapia intraperitoneal hipertérmica; Transfusión