Intraoperative metabolic changes associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Area of Science:

• Oncology
• Surgical Oncology
• Anesthesiology

Background:

• Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is a complex procedure.
• This treatment induces significant hemodynamic, respiratory, and metabolic disturbances during the perioperative phase.

Purpose of the Study:

• To investigate the metabolic alterations occurring during and after CRS plus HIPEC.
• To identify perioperative factors associated with patient morbidity to optimize treatment protocols.

Main Methods:

• A retrospective analysis of prospectively collected data from 219 patients undergoing CRS plus HIPEC between January 2018 and December 2020.
• Evaluation of metabolic parameters including pH, electrolytes, glucose, and temperature, comparing pre-HIPEC and post-HIPEC values.

Main Results:

• Significant perioperative metabolic changes were observed, including variations in pH, lactic acid, sodium, potassium, glucose, bicarbonate, and temperature (p < 0.05).
• The closed HIPEC technique led to a higher temperature increase compared to the open technique (p < 0.05), without increased morbidity.
• Multivariate analysis identified patient age, pre-HIPEC glycemia, and post-HIPEC potassium levels as significant prognostic factors for morbidity.

Conclusions:

• HIPEC administration post-CRS induces substantial shifts in internal homeostasis.
• While the closed HIPEC technique increases temperature, it does not correlate with higher morbidity.
• Patient age, pre-HIPEC glucose levels, and post-HIPEC potassium levels are key predictors of morbidity.