A review of 111 anaesthetic patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

Introduction: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are the treatment of choice for selected patients with peritoneal carcinomatosis, which was previously a lethal condition with dismal survival rate. Methods: We reviewed all CRS and HIPEC procedures performed at our centre from January 1997 to December 2012, with a focus on perioperative events and anaesthetic implications. Results: In total, 111 patients underwent 113 procedures. Mean age of patients was 51.7 (range 14–74) years and 84.1% were women. Mean surgery duration was 9 hours 10 minutes ± 2 hours 56 minutes. Most tumours were ovarian or colorectal in origin and 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, 78.8% of patients required intensive care, as 75.2% of the 113 procedures required interval extubation. Patients with lower PCI scores were more likely to be extubated immediately post-operation (p < 0.05). A total of 80 (80.0%) patients had coagulopathy postoperatively, which was associated with longer HIPEC duration (p < 0.05). Median lengths of intensive care unit and hospital stays were 2 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 and surgical complications (such as anastomotic or wound dehiscence), and intra-abdominal infections. Conclusion: CRS and HIPEC are major surgeries with significant morbidity, as highlighted by the perioperative concerns observed in our study.