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Porcine Normothermic Isolated Liver Perfusion
Published on: June 9, 2023
825
Perfusion Instability During Hyperthermic Intraperitoneal Chemotherapy: The Utility of a Problem-solving Flowchart
Chiara Soligo1, Carola Cenzi2, Francesca Foscaro1
1Surgical Oncology of the Digestive Tract, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy.
In Vivo (Athens, Greece)
|December 31, 2024
Summary
Perfusion instability (PI) during hyperthermic intra-peritoneal chemotherapy (HIPEC) occurred in 10.1% of cases. A structured problem-solving approach effectively managed PI, maintaining target temperatures and limiting adverse effects in cytoreductive surgery (CRS)-HIPEC procedures.
Area of Science:
- Oncology
- Surgical Oncology
- Chemotherapy Delivery
Background:
- Perfusion instability (PI) is a critical adverse event during hyperthermic intra-peritoneal chemotherapy (HIPEC), defined as the inability to maintain adequate perfusion flow and target temperature.
- Management strategies for PI during closed cytoreductive surgery (CRS)-HIPEC are not well-documented.
- This study investigates the incidence of PI and the efficacy of a problem-solving approach in managing this complication.
Purpose of the Study:
- To evaluate the incidence of perfusion instability (PI) during closed cytoreductive surgery (CRS)-HIPEC.
- To assess the effectiveness of a systematic problem-solving approach in managing PI.
- To identify factors influencing PI and its resolution during HIPEC.
Main Methods:
- A retrospective analysis of 208 CRS-HIPEC procedures performed between May 2018 and January 2023.
- PI was defined by the inability to maintain a target flow of 1,100 ml/min and a temperature of 41°C.
- A problem-solving flowchart involving drain checks, muscle relaxation assessment, patient positioning, volume adjustment, and drain switch manipulation was implemented.
Main Results:
- Perfusion instability (PI) occurred in 10.1% of HIPEC procedures (21 out of 208 cases).
- Patients experiencing PI had significantly longer perfusion times and lower mean outflow pressure and flow rates (p<0.001).
- Despite PI, the target temperature of 41°C was successfully maintained throughout the HIPEC procedure.
Conclusions:
- A structured problem-solving approach, executed by the HIPEC perfusionist team, successfully resolved most instances of PI.
- Further investigation into perfusion technical aspects and fluid volume calculations is recommended to enhance prevention and management of PI.
- The findings support the utility of a systematic approach to manage PI during CRS-HIPEC, ensuring treatment efficacy.
