title: Lack of significant intraoperative coagulopathy in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) indicates that epidural anaesthesia is a safe option.
abstract: OBJECTIVE
  The purpose of this study is to evaluate the fluctuations of coagulation parameters during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) and confirm beyond doubt that epidural anaesthesia is safe with this type of operations.
  
  
  METHODS
  This is a prospective clinical study of consecutive patients who had cytoreductive surgery and HIPEC. An epidural catheter was inserted into all patients. Peripheral venous blood samples in specific time points of the procedure were tested for complete blood count, prothrombin time (PT), activated partial thromboplastin time (aPTT), international normalised ratio (INR), fibrinogen, D-dimer, and expression of the GpIIb/IIIa platelet receptor.
  
  
  RESULTS
  A total of 51 consecutive patients were included in this study. The initial mean (SD) platelet count decreased significantly to a mean of 250.6 (105.4) 10(9)/L (p < 0.001). Fibrinogen levels decreased to 295.9 (127.4) mg/dL (p = 0.009). D-dimer levels increased to 5.3 (3.1) mg/dL (p < 0.001). APTT increased from 30.8 (5.8) s to 35.1 (4.6). The mean INR increased significantly to 1.5 (0.5) (p < 0.001). The total number of GpIIb/IIIa platelet receptors showed no significant variation throughout the measurements and was 72603.2 before HIPEC, 80772.4 during, and 77432.1 after. All the parameters examined, despite significant fluctuations remained in levels that would permit perioperative epidural analgesia. No related complications were recorded.
  
  
  CONCLUSIONS
  Our results support the belief that epidural analgesia is a safe option in cytoreductive surgery and HIPEC despite certain intraoperative fluctuations in coagulation parameters. It is of major importance to regulate any abnormalities observed during surgery. There are no available data regarding the occurrence of coagulopathy in the post-operative period.
authors.affiliation: a Department of Anaesthesiology , Didimoticho General Hospital , Didimoticho , Greece .
authors.forename: Odysseus
authors.initials: O
authors.lastname: Korakianitis
authors.affiliation: b Department of Haematology , Sismanogleio Hospital , Athens , Greece .
authors.forename: Telemachos
authors.initials: T
authors.lastname: Daskalou
authors.affiliation: c Department of Surgery , Didimoticho General Hospital , Didimoticho , Greece , and.
authors.forename: Leonidas
authors.initials: L
authors.lastname: Alevizos
authors.affiliation: c Department of Surgery , Didimoticho General Hospital , Didimoticho , Greece , and.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Stamou
authors.affiliation: a Department of Anaesthesiology , Didimoticho General Hospital , Didimoticho , Greece .
authors.forename: Christos
authors.initials: C
authors.lastname: Mavroudis
authors.affiliation: d Department of Anesthesiology , Medical School, Democritus University of Thrace , Alexandroupoli , Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Iatrou
authors.affiliation: d Department of Anesthesiology , Medical School, Democritus University of Thrace , Alexandroupoli , Greece.
authors.forename: Theodosia
authors.initials: T
authors.lastname: Vogiatzaki
authors.affiliation: d Department of Anesthesiology , Medical School, Democritus University of Thrace , Alexandroupoli , Greece.
authors.forename: Savvas
authors.initials: S
authors.lastname: Eleftheriadis
authors.affiliation: c Department of Surgery , Didimoticho General Hospital , Didimoticho , Greece , and.
authors.forename: Antonios Apostolos
authors.initials: AA
authors.lastname: Tentes
mesh_terms: D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001777:Blood Coagulation; D002945:Cisplatin / Q000008:administration & dosage / Q000627:therapeutic use; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D004317:Doxorubicin / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006801:Humans; D006979:Hyperthermia, Induced; D039661:Integrin beta3 / Q000378:metabolism; D008297:Male; D008558:Melphalan / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage / Q000627:therapeutic use; D010534:Peritoneal Neoplasms / Q000097:blood / Q000628:therapy*; D010976:Platelet Count; D019038:Platelet Glycoprotein GPIb-IX Complex / Q000378:metabolism; D055815:Young Adult; D000093542:Gemcitabine
chemical_list: D000970:Antineoplastic Agents; D039661:Integrin beta3; D019038:Platelet Glycoprotein GPIb-IX Complex; C032193:glycoprotein receptor GPIb-IX; D003841:Deoxycytidine; D016685:Mitomycin; D004317:Doxorubicin; D005340:Fibrinogen; D002945:Cisplatin; D008558:Melphalan; D000093542:Gemcitabine
keywords: Cytoreductive surgery; HIPEC; coagulopathy; epidural anesthesia; intraperitoneal chemotherapy