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Thromboelastogram changes are associated with postoperative complications after cytoreductive surgery.

Noam Goder¹, Lilach Zac^2,3, Nadav Nevo¹

¹Department of Surgery B, Peritoneal Surface Malignancy and Melanoma Unit, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.

Pleura and Peritoneum

|November 15, 2024

Summary

Changes in thromboelastogram (TEG) values after cytoreductive surgery (CRS) are linked to severe postoperative complications (SPC). TEG may help predict and manage patient risk during and after CRS and hyperthermic intraperitoneal chemotherapy (HIPEC).

Keywords:

hyperthermic intraperitoneal chemotherapy postoperative complications thromboelastogram

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Area of Science:

Oncology
Surgical Oncology
Anesthesiology

Background:

Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is a critical treatment for peritoneal surface malignancies.
High surgical morbidity and limited prediction of severe postoperative complications (SPC) remain significant challenges.
Thromboelastogram (TEG) is a viscoelastic measure of hemostasis, but its utility in predicting SPC after CRS is not well-established.

Purpose of the Study:

To investigate the association between changes in thromboelastogram (TEG) values following cytoreductive surgery (CRS) and the occurrence of severe postoperative complications (SPC).
To determine if intraoperative TEG parameters can serve as predictive markers for SPC in patients undergoing CRS and hyperthermic intraperitoneal chemotherapy (HIPEC).

Main Methods:

Retrospective analysis of a cohort of 37 patients who underwent CRS and HIPEC.
TEG measurements were obtained before and after CRS.
Clinical and postoperative data, including SPC, were collected from a prospectively maintained database.

Main Results:

Patients who experienced SPC exhibited significantly increased R-time and K-time on TEG compared to those without SPC (p=0.01 and p=0.03, respectively).
Multivariable analysis indicated that TEG values were significantly associated with SPC (odds ratio=1.53, p=0.05).
No significant differences were observed in patient demographics, tumor histology, extent of surgery, or preoperative chemotherapy between groups with and without SPC.

Conclusions:

TEG parameter changes following CRS are significantly associated with the development of severe postoperative complications.
Intraoperative TEG monitoring may provide valuable insights for predicting SPC.
These findings suggest that TEG could guide intraoperative decision-making and postoperative patient management, including triage to appropriate care levels.