A review of 111 anaesthetic patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
BACKGROUND
Cytoreductive surgery (CRS) along with hyperthermic intraperitoneal chemotherapy (HIPEC) is the treatment of choice for selected patients with peritoneal carcinomatosis, a previously lethal condition with dismal survival rates.


METHODS
We reviewed CRS and HIPEC procedures performed at our centre from January 1997 to December 2012, focusing on perioperative events and anaesthetic implications.


RESULTS
In total, 111 patients underwent 113 procedures. Mean age of the patients was 51.7 (range 14-74) years and 84.1% were women. Mean duration of surgery was 9 hours 10 minutes ± 2 hours 56 minutes. Most tumours were ovarian or colorectal in origin, and the mean peritoneal cancer index (PCI) score was 14.3 ± 8.9. Mean estimated blood loss was 1,481 ± 1,064 mL. Mean total intravenous fluids and blood products administered was 8,498 ± 3,941 mL. Postoperatively, 79.5% of the patients needed intensive care, as 75.2% of the 113 procedures required interval extubation. Patients with lower PCI scores were more likely to be extubated immediately after surgery (p < 0.05). 80.0% of patients had coagulopathy postoperatively, and this was associated with longer HIPEC duration (p < 0.05). Median lengths of intensive care unit and hospital stays were two days and 14 days, respectively. Longer duration of surgery significantly correlated with longer hospitalisation. Prolonged hospitalisation was due to nosocomial pneumonia, pleural effusions, respiratory failure, sepsis, surgical complications (such as anastomotic or wound dehiscence), and intra-abdominal infections.


CONCLUSIONS
The CRS and HIPEC technique is a major surgery with significant morbidity, as highlighted by the perioperative concerns observed in our study.
Department of Anaesthesia, Singapore General Hospital, Singapore.
Sze Ying
SY
Thong
Division of Surgical Oncology, National Cancer Centre Singapore, Singapore.
Claramae Shulyn
CS
Chia
Department of Anaesthesia, Singapore General Hospital, Singapore.
Oriana
O
Ng
Division of Surgical Oncology, National Cancer Centre Singapore, Singapore.
Grace
G
Tan
Department of Anaesthesia, Singapore General Hospital, Singapore.
Ee Teng
ET
Ong
Division of Surgical Oncology, National Cancer Centre Singapore, Singapore.
Khee Chee
KC
Soo
Division of Surgical Oncology, National Cancer Centre Singapore, Singapore.
Melissa
M
Teo
D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures / Q000379:methods*; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D011182:Postoperative Care; D012189:Retrospective Studies; D055815:Young Adult
anaesthesia; cytoreductive surgery; intraperitoneal chemotherapy