Rohan HP McLachlan1,2,3*, Raphael Shamavonian1,4, Oliver M Fisher1,3, Nayef A Alzahrani1,5, Sarah J Valle1, Winston Liauw3,6 and David L Morris1,3
1Department of Surgery, St George Hospital, Australia 2University of New South Wales, Australia 3St George Hospital Clinical School, University of New South Wales, Australia 4School of Medicine, University of Notre Dame, Australia 5College of Medicine, Al-Imam Mohammad Ibn Saud Ismalic University, Saudi Arabia 6Cancer Care Centre, St George Hospital, AustraliaFulltext PDF
Purpose: To examine the variability of fluid administration during Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Methods: This retrospective cohort study included consecutive patients undergoing CRS/HIPEC between 2010 to 2017 at St. George Hospital, Sydney. Anaesthetic charts were reviewed and volumes of crystalloids, albumin and blood products were extracted. Results were stratified by anaesthetist, tumour type and tumour volume as depicted by the Peritoneal Cancer Index (PCI). Results: Twelve consultant anesthetists were involved in the surgeries of 335 patients. The median total volume of Intraoperative Fluid (IOF) administered per case was 11050 mL (range, 3000 to 45700) at a rate of 17 ml/kg/hr (Interquartile Range [IQR], 12 to 23). The median volume of blood products administered was 3330 ml (IQR, 1700 to 6400) at a rate of 5 ml/kg/hr (IQR, 3 to 9). Over 7200 units of blood products were used in all surgeries. IOF rates varied substantially with PCI. There was a clear linear relationship seen with every increase in PCI by one point resulting in an increase of 0.2 ml/kg/hr fluid (p<0.001). Equally, the proportion of blood products increased with increasing PCI at the cost of crystalloid and albumin administration. When comparing tumour types, the median IOF rate was almost double in colorectal cancer compared to other tumour types (p<0.004). There was significant variation in the rate of blood products administered between individual anesthetists (p<0.001). Conclusion: To our knowledge, this is the first detailed report on the volumes and types of fluids administered during CRS/HIPEC. Outcome analyses will facilitate an informed discussion regarding standardization of treatment and fluid administration protocols for these complex patients.
Peritoneal carcinomatosis; Cytoreductive surgery; Intraperitoneal chemotherapy; Intraoperative fluid management; Anesthetics
McLachlan RHP, Shamavonian R, Fisher OM, Alzahrani NA, Valle SJ, Liauw W, et al. Variations in Intraoperative Fluid Administration during Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy. J Gastroenterol Hepatol Endosc. 2019;4(3):1064..