Hemodynamic and cardiovascular problems during modified hyperthermic intraperitoneal perioperative chemotherapy

Area of Science:

• Oncology
• Surgical Oncology
• Cardiovascular Physiology

Background:

• Cytoreductive surgery with hyperthermic intraperitoneal perioperative chemotherapy (HIPEC) improves survival for peritoneal carcinomatosis.
• HIPEC is particularly effective for low-grade tumors like ovarian and appendiceal adenocarcinoma, pseudomyxoma, and grade I gastric/colorectal cancers.

Purpose of the Study:

• To prospectively measure hemodynamic and cardiac functions during HIPEC.
• To assess the impact of HIPEC on urinary output and circulating volume.

Main Methods:

• Hemodynamic and cardiac functions were monitored in 60 patients undergoing HIPEC.
• Urinary output was measured throughout the hyperthermic intraoperative intraperitoneal chemotherapy procedure.

Main Results:

• HIPEC induced a hyperdynamic circulatory state with increased heart rate and cardiac output.
• Systemic vascular resistance decreased, body temperature increased, and effective circulating volume decreased.
• Urinary output showed a tendency to decrease as HIPEC progressed.

Conclusions:

• HIPEC necessitates increased intravenous fluid administration to manage the hyperdynamic state and prevent complications from increased intra-abdominal pressure.
• Maintaining adequate urinary output through titrated intravenous fluids is key to achieving cardiac stability during HIPEC.