title: Time course of cytokines, hemodynamic and metabolic parameters during hyperthermic intraperitoneal chemotherapy.
abstract: BACKGROUND
  Systemic response to cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) causes the activation of endocrine, metabolic, hemodynamic and inflammatory processes. The aim of this work is to describe and analyze the time course of the inflammatory markers concentration during CRS+HIPEC in plasma and peritoneal fluids and the association with hemodynamic and metabolic parameters.
  
  
  METHODS
  Pre-, Intra- and Post-operative data were collected. Tumor necrosis factor (TNF), interleukine 6, procalcitonine (PCT), cancer antigen 125 (CA-125) in blood and in peritoneal fluids were evaluated.
  
  
  RESULTS
  Thirty-eight patients included, 29 (76.3%) female. Mean/median PCI: 9.2/5. Primary malignancy: 5 colo-rectal (13.2%), 5 gastric (13.2%), 23 ovarian (60.5%) and 5 others (13.2%). CCR 0-1 reached in all patients. Cardiac Index, Heart rate and Central Venous Pressure, increased during the procedure while Stroke Volume Variation showed a decrease. Mean Arterial Pressure and Superior Vena Cava Oxygenation were stable through the whole procedure. TNF and CA-125 were steady during the whole procedure; IL-6 had a relevant increase from baseline to start of perfusion (p<0.01); PCT had a steady increase at every time point. Peritoneal sampling showed a statistically significant increase (p<0.01) between start and end of the perfusion phase for all markers but TNF. Serum and peritoneal marker concentration were similar for TNF, PCT and CA-125. IL-6 showed a sharp difference.
  
  
  CONCLUSIONS
  The most significant variations are those of IL-6 and PCT. The cytokines level parallel the hemodynamic derangements. Treatment during HIPEC should mimic the established treatment during sepsis and septic shock.
authors.affiliation: General surgery dept., Papa Giovanni XXIII Hospital, Bergamo, Italy - federico.coccolini@gmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Coccolini
authors.forename: D
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authors.lastname: Corbella
authors.forename: P
authors.initials: P
authors.lastname: Finazzi
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authors.lastname: Brambillasca
authors.forename: A
authors.initials: A
authors.lastname: Benigni
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authors.lastname: Prussiani
authors.forename: M
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authors.lastname: Ceresoli
authors.forename: R
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authors.lastname: Manfredi
authors.forename: E
authors.initials: E
authors.lastname: Poiasina
authors.forename: P
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authors.lastname: Bertoli
authors.forename: F
authors.initials: F
authors.lastname: Catena
authors.forename: A
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authors.lastname: Bianchetti
authors.forename: M
authors.initials: M
authors.lastname: Bontempelli
authors.forename: L F
authors.initials: LF
authors.lastname: Lorini
authors.forename: V
authors.initials: V
authors.lastname: Sonzogni
authors.forename: L
authors.initials: L
authors.lastname: Ansaloni