Intraoperative fluid restriction in hyperthermic intraperitoneal chemotherapy.

Area of Science:

• Oncology
• Surgical Oncology
• Anesthesiology

Background:

• Liberal fluid administration is common in cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC).
• However, over-resuscitation can lead to delayed recovery and impaired wound healing.
• This study introduces an intraoperative fluid restriction protocol to mitigate these risks.

Purpose of the Study:

• To evaluate the safety and feasibility of a fluid restriction protocol during CRS with HIPEC.
• To assess the impact of fluid restriction on patient morbidity and recovery.
• To minimize complications associated with fluid management in this complex surgical setting.

Main Methods:

• A retrospective analysis of 35 patients undergoing CRS-HIPEC for curative intent was conducted.
• The protocol involved continuous vasopressin infusion and strict urine output monitoring (0.5 mL/kg/h).
• Fluid intake was managed using crystalloids and colloids, with Clavien-Dindo grade ≥3 events as the primary endpoint.

Main Results:

• The study included 35 patients (median age 56 years, 71% female) with various malignancies.
• Complete cytoreduction was achieved in 91% of patients, with a median peritoneal cancer index of 15.
• Median return of bowel function was 5 days, and median hospital stay was 7 days, with only 5 patients experiencing Clavien-Dindo grade 3-4 events.

Conclusions:

• A fluid restriction protocol is safe and feasible for patients undergoing CRS-HIPEC for curative purposes.
• This approach can minimize intraoperative fluid administration while maintaining acceptable patient outcomes.
• Further research may support the wider adoption of fluid restriction in CRS-HIPEC procedures.