Lucillia Bezu1, Mégane Raineau2, Myriam Deloménie3, Bernard Cholley4, Romain Pirracchio5. 1. Service d'anesthésie, hôpitaux universitaires Paris Ouest, hôpital européen Georges Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France. Electronic address: lucilliabe@gmail.com. 2. Service d'anesthésie, hôpitaux universitaires Paris Ouest, hôpital européen Georges Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France. 3. Service de chirurgie cancérologique gynécologique et du sein, hôpitaux universitaires Paris Ouest, hôpital européen Georges Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France. 4. Service d'anesthésie, hôpitaux universitaires Paris Ouest, hôpital européen Georges Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Inserm UMR S1140, Paris, France. 5. Service d'anesthésie, hôpitaux universitaires Paris Ouest, hôpital européen Georges Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
Abstract
CONTEXT: Hyperthermic intraperitoneal chemotherapy (HIPEC) is a surgical technique for peritoneal carcinomatosis combining cytoreduction surgery and peritoneal irrigation of cytotoxic agents responsible for haemodynamics and fluid homeostasis alterations. To this day, no guidelines exist concerning intraoperative management. OBJECTIVES: To review data on haemodynamic monitoring and management of patients undergoing HIPEC and to help design a standardised anaesthetic protocol. DATA SOURCES: MEDLINE, EMBASE and Cochrane library were searched using the following. STUDY SELECTION: Original articles and case-reports. Letters to editors and reviews were excluded. DATA EXTRACTION: Data on haemodynamic management, morbidity and mortality. DATA SYNTHESIS: Haemodynamic management during HIPEC is highly variable and depends on local protocols. Only one randomised controlled trial evaluated the benefit of goal-directed fluid administration (GDFA). GDFA guided by advanced haemodynamic monitoring resulted in significantly less complication, shorter length of stay and less mortality compared to standard fluid administration. Renal protection protocol did not decrease the risk of acute kidney injury (AKI). CONCLUSION: Our review reveals that fluid administration guided by advanced monitoring seems to be associated with less postoperative morbidity and mortality after HIPEC. Nevertheless, the literature review shows that intraoperative haemodynamic management is highly variable for this surgery. The use of renal protection strategy does not decrease the prevalence of AKI. Further prospective trials comparing different fluid management and haemodynamic monitoring strategies are urgently needed (PROSPERO registration CRD42018115720).
CONTEXT: Hyperthermic intraperitoneal chemotherapy (HIPEC) is a surgical technique for peritoneal carcinomatosis combining cytoreduction surgery and peritoneal irrigation of cytotoxic agents responsible for haemodynamics and fluid homeostasis alterations. To this day, no guidelines exist concerning intraoperative management. OBJECTIVES: To review data on haemodynamic monitoring and management of patients undergoing HIPEC and to help design a standardised anaesthetic protocol. DATA SOURCES: MEDLINE, EMBASE and Cochrane library were searched using the following. STUDY SELECTION: Original articles and case-reports. Letters to editors and reviews were excluded. DATA EXTRACTION: Data on haemodynamic management, morbidity and mortality. DATA SYNTHESIS: Haemodynamic management during HIPEC is highly variable and depends on local protocols. Only one randomised controlled trial evaluated the benefit of goal-directed fluid administration (GDFA). GDFA guided by advanced haemodynamic monitoring resulted in significantly less complication, shorter length of stay and less mortality compared to standard fluid administration. Renal protection protocol did not decrease the risk of acute kidney injury (AKI). CONCLUSION: Our review reveals that fluid administration guided by advanced monitoring seems to be associated with less postoperative morbidity and mortality after HIPEC. Nevertheless, the literature review shows that intraoperative haemodynamic management is highly variable for this surgery. The use of renal protection strategy does not decrease the prevalence of AKI. Further prospective trials comparing different fluid management and haemodynamic monitoring strategies are urgently needed (PROSPERO registration CRD42018115720).