Fatal arrhythmia following intraoperative continuous hyperthermic peritoneal perfusion chemotherapy

Area of Science:

• Oncology
• Cardiology
• Surgical Oncology

Background:

• Advanced gastric cancer with peritoneal carcinomatosis presents significant treatment challenges.
• Continuous hyperthermic peritoneal perfusion chemotherapy (CHPPC) is an established method for managing peritoneal tumor seeding.
• Intraoperative complications during oncologic procedures require vigilant monitoring and rapid intervention.

Observation:

• A 65-year-old male with advanced gastric cancer and extensive intraabdominal carcinomatosis developed life-threatening ventricular dysrhythmia during CHPPC.
• The dysrhythmia occurred post-tumor eradication but prior to completion of the perfusion chemotherapy.
• The patient's cardiac rhythm was unstable with a rate of 120 beats/min.

Findings:

• The patient received immediate cardiopulmonary resuscitation, fluid resuscitation, electrolyte correction, and body cooling.
• These interventions successfully restored effective cardiopulmonary circulation.
• No long-term sequelae were observed following the management of the intraoperative cardiac event.

Implications:

• CHPPC can be safely administered in advanced cancer patients, even with complex intraabdominal disease.
• Prompt recognition and management of intraoperative cardiac events are crucial for patient safety during CHPPC.
• This case highlights the importance of multidisciplinary care, integrating oncology, cardiology, and critical care principles.