02 / Postoperative outcomes of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC)

Background: CRS/HIPEC is performed to treat diseases such as pseudomyxoma peritonei, carcinomatosis, and malignant mesothelioma. Itu2019s highly invasive, and requires complicated surgical manipulation. Therefore it requires large volumes of fluid/blood transfusion to address ascites and/or bleeding, which can result in various complications. This study retrospectively examined the postoperative outcomes and factors contributing to the outcomes in our hospital.Methods:Data on patients who underwent CRS/HIPEC between 2010 and 2017 were extracted from electronic health record in our hospital. The relationships between postoperative outcomes and patient backgrounds or intraoperative factors were examined through multivariate analysis.Results and Discussion:Subjects were 166 patients (61 men and 105 women, mean age 56.7u00b112.7 years). Median operative time was 682 minutes, median volumes of blood loss, ascites, total fluid infusion, red blood cell (RBC) transfusion, fresh frozen plasma (FFP) transfusion were 627 mL, 2189 mL, 8075 mL, 840 mL, 1815 mL, respectively. The median intubation duration was 2 days, the median length of intensive care unit (ICU) stay was 6 days. Grade III or higher postoperative complications according to the Clavien-Dindo classification occurred in 39/166 patients (23.5%), of which 1 patient died. The most frequent complication was intra-abdominal bleeding in 11 patients (6.6%), followed by respiratory complication in 6 (3.6%), cardiac complication in 4 (2.4%), and disseminated intravascular coagulation in 3 (1.8%). Risk factors for all complications were operative time, crystalloid infusion, and RBC transfusion. The length of ICU stay was longer in patients with longer operative time. Results of this study showed that operative time was most strongly associated with postoperative outcomes. This association was considered mainly related to the number of resected organs, extent of resection, and surgical manipulation such as adhesiolysis.Close collaboration with operators is essential for safe anesthesia management. Additionally, adequate management of fluid/blood transfusion is required to prevent disease progression and related complications.Conclusion:The incidence of postoperative complication of CRS/HIPEC in our hospital was 23.5%. Close collaboration with operators and adequate fluid/blood management is required.