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 postoperative data were collected. Tumor necrosis factor (TNF), interleukine 6 (IL-6), pro-calcitonin (PCT), cancer antigen 125 (CA-125) in blood and in peritoneal fluids were evaluated.
  
  
  RESULTS
  Thirty-eight patients were included, 29 (76.3%) of them were female. Mean/median PCI was 9.2/5, primary malignancy was 5 colorectal cancer (13.2%), 5 gastric cancer (13.2%), 23 ovarian cancer (60.5%) and 5 other malignancies (13.2%). Combined clinical risk 0-1 was 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 throughout 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 were in IL-6 and PCT levels. The cytokines level parallels the hemodynamic derangements. Treatment during HIPEC should mimic the established treatment during sepsis and septic shock.
authors.affiliation: Department of General Surgery, "Papa Giovanni XXIII" Hospital, Bergamo, Italy - federico.coccolini@gmail.com.
authors.forename: Federico
authors.initials: F
authors.lastname: Coccolini
authors.forename: Davide
authors.initials: D
authors.lastname: Corbella
authors.forename: Paolo
authors.initials: P
authors.lastname: Finazzi
authors.forename: Pietro
authors.initials: P
authors.lastname: Brambillasca
authors.forename: Alberto
authors.initials: A
authors.lastname: Benigni
authors.forename: Viviana
authors.initials: V
authors.lastname: Prussiani
authors.forename: Marco
authors.initials: M
authors.lastname: Ceresoli
authors.forename: Roberto
authors.initials: R
authors.lastname: Manfredi
authors.forename: Elia
authors.initials: E
authors.lastname: Poiasina
authors.forename: Paolo
authors.initials: P
authors.lastname: Bertoli
authors.forename: Fausto
authors.initials: F
authors.lastname: Catena
authors.forename: Andrea
authors.initials: A
authors.lastname: Bianchetti
authors.forename: Mario
authors.initials: M
authors.lastname: Bontempelli
authors.forename: Luca F
authors.initials: LF
authors.lastname: Lorini
authors.forename: Valter
authors.initials: V
authors.lastname: Sonzogni
authors.forename: Luca
authors.initials: L
authors.lastname: Ansaloni
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001202:Ascitic Fluid / Q000737:chemistry; D003131:Combined Modality Therapy; D016207:Cytokines / Q000097:blood*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006979:Hyperthermia, Induced; D007274:Injections, Intraperitoneal; D008297:Male; D008660:Metabolism / Q000502:physiology*; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000188:drug therapy / Q000378:metabolism; D011446:Prospective Studies
chemical_list: D000970:Antineoplastic Agents; D016207:Cytokines