Elevated Maximum Core Body Temperature During Hyperthermic Intraperitoneal Chemoperfusion (HIPEC) is Associated with
Ryan J Hendrix1, Jonathan P Kassira1, Laura A Lambert2
1Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
Annals of Surgical Oncology
|July 10, 2019
Summary
Elevated core body temperature (CBT) during cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion (HIPEC) increases postoperative complications. Optimizing HIPEC flow rates may improve patient outcomes by managing CBT.
Area of Science:
- Oncology
- Surgical Oncology
- Hyperthermia Therapy
Background:
- Hyperthermia augments chemotherapy efficacy during cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC).
- Elevated core body temperature (CBT) during these procedures can lead to increased surgical morbidity.
- The relationship between maximum CBT and postoperative outcomes requires evaluation.
Purpose of the Study:
- To assess the impact of maximum core body temperature (CBT) during cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC) on postoperative outcomes.
- To identify potential correlations between intraoperative CBT thresholds and patient morbidity.
- To explore the influence of HIPEC flow rates on CBT and peritoneal heating.
Main Methods:
- Retrospective review of 135 patients undergoing CRS/HIPEC from January 2011 to July 2017.
- Outcomes stratified based on maximum CBT achieved during HIPEC.
- Primary endpoints included 30-day morbidity and complication severity (Clavien-Dindo classification).
Main Results:
- 27% of patients reached a maximum CBT ≥ 39.5°C.
- Higher CBT (≥ 39.5°C) correlated with increased 30-day postoperative complications (58% vs. 34%, p=0.01) and severe complications (22% vs. 11%, p=0.04).
- Multivariate analysis indicated CBT ≥ 39.5°C significantly increased the odds of any complication (OR 3.77) and severe complications (OR 3.46).
- Higher flow rates (≥ 2.35 L/min) were associated with lower CBT (p=0.05) and improved peritoneal heating (p=0.02).
Conclusions:
- Maximum CBT ≥ 39.5°C during HIPEC is linked to a higher risk of postoperative morbidity.
- Implementing higher flow rates during HIPEC may enhance intraperitoneal heating and reduce CBT.
- Optimizing HIPEC parameters, including flow rate, could improve therapeutic benefits and patient safety.
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