Metabolic and hematological disorders of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC)

Authors

Gómez G, Ferrer A, Esteve N, Fabian D, Melero C, Mora LC. 

Research Focus

Cytoreductive surgery (CS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) produces important metabolic and hematological disorders during the entire perioperative period.
We present the evolution of metabolic and hematological parameters of patients who underwent CS with HIPEC.

Methods

A prospective descriptive study was conducted of consecutive patients with Peritoneal Carcinomatosis (CP) who underwent CS with HIPEC between March 2014 and February 2015. We applied an anaesthesia protocol and goal-directed hemodynamic and metabolic therapy.

Results

24 patients were included (mean age 58 ± 13.3 years, 58% ovarian cancer, 33% colorectal cancer).
The pH decreased from 7.42 [7.32 - 7.57] to 7.28 [7.26 - 7.30] during HIPEC. Lactate values increased during the HIPEC  up to 3.38 mmol ·L -1 [2.81 - 4.0], which normalized on the 1st postoperative day without any treatment. 

Hyperglicemia, 396 mg/dl [379-426], occurred during HIPEC in the first 12 patients when using glucose 5% as solvent of cytostatic. The hyperglicemia dissapeared after using glucose 1,25% as solvent. 

75% of patients had hypophosphatemia, 92% hypomagnesemia and 46% hypocalcemia. All patients showed hypoalbuminemia. 29% of patients were transfused during surgery, with an average of 2 red blood cells pack per patient. There were no differences of hemoglobin levels at the beginning of the CS between transfused or not transfused patients 9.4 (8.1-10.7) vs 10.7 (9.7 - 11.3) (p = 0.114).

Lower Platelet and higher INR means values were recorded the second postoperative day, being 159·109 l-1 [73-341] and 1.41 [1.21 - 1.94], respectively, regaining normal values without treatment .

Conclusions

In line with other studies1, metabolic non-hipercloremic acidosis is self-limiting and does not require treatement. Balanced fluid therapy should be used to prevent an increase in acidosis. The use of Cytostatic solvent glucose 1,25% avoid the hyperglicemia and insulin infusion2. Hypomagnesemia, hypocalcemia and hypoalbuminemia usually requires systematic replacement. Preoperative treatment of the anemia could be considered. Coagulation abnormalities had normalized after the third day in most patients. without treatment.  

Bibliography
1. Webb CA,  Anesth Analg. 2013
2. Pascual J. Arch Gynecol Obstet. 2014
3. Raytis J.L. OJANES 2014