Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.07.018
Brazilian Journal of Anesthesiology
Original Investigation

Fluid administration in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: neither too much nor too little

Administração de fluidos em cirurgia citorredutora com quimioterapia intraperitoneal hipertérmica: nem muito nem muito pouco

Maria Elvira Castellanos Garijo; Ana Sepúlveda Blanco; Jose Tinoco Gonzalez; Alicia Merinero Casado; Juan Ignacio Medina de Moya; Gabriel Yanes Vidal; Ana Forastero Rodriguez; Cristobalina Ángeles Martin García; Francisco Cristobal Muñoz-Casares; Javier Padillo Ruiz

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Abstract

Introduction
Intraoperative fluid therapy in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy plays an important role in postoperative morbidity. Studies have found an association between overload fluid therapy and increased postoperative complications, advising restrictive intraoperative fluid therapy. Our objective in this study was to compare the morbidity associated with restrictive versus non-restrictive intraoperative fluid therapy.

Methods
Retrospective analysis of a database collected prospectively in the Anesthesiology Service of Virgen del Rocío Hospital, from December 2016 to April 2019. One hundred and six patients who underwent complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy were divided into two cohorts according to Fluid Therapy received 1. Restrictive ≤ 9 mL.kg-1.h-1 (34 patients), 2. Non-restrictive ≥ 9 mL.kg-1.h-1 (72 patients). Percentage of major complications (Clavien-Dindo grade III–IV) and length hospital stay were the main outcomes variables.

Results
Of the 106 enrolled patients, 68.9% were women; 46.2% had ovarian cancer, 35.84% colorectal cancer, and 7.5% peritoneal cancer. The average fluid administration rate was 11 ± 3.58 mL.kg-1.h-1. The restrictive group suffered a significantly higher percentage of Clavien-Dindo grade III–IV complications (35.29%) compared with the non-restrictive group (15.27%) (p = 0.02). The relative risk associated with restrictive therapy was 1.968 (95% confidence interval: 1.158–3.346). We also found a significant difference for hospital length of stay, 20.91 days in the restrictive group vs 16.19 days in the non-restrictive group (p = 0.038).

Conclusions
Intraoperative fluid therapy restriction below 9 mL.kg-1.h-1 in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy was associated with a higher percentage of major postoperative complications.

Keywords

Cytoreductive surgery;  Hyperthermic intraperitoneal chemotherapy;  Intraoperative Fluid Therapy;  Oncotic Pressure;  Major postoperative complications

Resumo

Introdução: A fluidoterapia intraoperatória em cirurgia citorredutora com quimioterapia intraperitoneal hipertérmica desempenha um papel importante na morbidade pós-operatória. Estudos encontraram associação entre sobrecarga de fluidoterapia e aumento de complicações pós-operatórias, aconselhando fluidoterapia intraoperatória restritiva. Nosso objetivo neste estudo foi comparar a morbidade associada à fluidoterapia intraoperatória restritiva versus não restritiva. Métodos: Análise retrospectiva de um banco de dados coletado prospectivamente no Serviço de Anestesiologia do Hospital Virgen del Rocío, de dezembro de 2016 a abril de 2019. Cento e seis pacientes submetidos à cirurgia citorredutora completa e quimioterapia intraperitoneal hipertérmica foram divididos em duas coortes de acordo com a fluidoterapia recebida 1. Restritivo ≤ 9 ml.kg-1.h-1 (34 pacientes), 2. Não restritivo ≥ 9 ml.kg-1.h-1 (72 pacientes). Percentual de complicações maiores (Clavien-Dindo grau III-IV) e tempo de internação foram as principais variáveis de desfecho. Resultados: Dos 106 pacientes inscritos, 68,9% eram mulheres; 46,2% tinham câncer de ovário, 35,84% câncer colorretal e 7,5% câncer peritoneal. A taxa média de administração de fluidos foi de 11 ± 3,58 ml´.kg-1.h-1. O grupo restritivo sofreu um percentual significativamente maior de complicações grau III-IV de Clavien-Dindo (35,29%) em comparação com o grupo não restritivo (15,27%) (p = 0,02). O risco relativo associado à terapia restritiva foi de 1,968 (intervalo de confiança de 95%: 1,158–3,346). Também encontramos diferença significativa para o tempo de internação, 20,91 dias no grupo restritivo vs 16,19 dias no grupo não restritivo (p=0,038). Conclusões: A restrição de fluidoterapia intraoperatória abaixo de 9 ml.kg-1.h-1 em cirurgia citorredutora com quimioterapia intraperitoneal hipertérmica foi associada a um maior percentual de complicações pós-operatórias maiores.

Palavras-chave

Cirurgia citorredutora; Quimioterapia intraperitoneal hipertérmica; Fluidoterapia Intraoperatória; Pressão Oncótica; Principais complicações pós-operatórias

References

1 N.J. Gusani, S.W. Cho, C. Colovos, et al. Aggressive surgical management of peritoneal carcinomatosis with low mortality in a high-volume tertiary cancer center Ann Surg Oncol, 15 (2008), pp. 754-763

2 D. Baratti, S. Kusamura, B. Laterza, et al. Early and long-term postoperative management following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy World J Gastrointest Oncol, 2 (2010), pp. 36-43

3 C. Raspé, L. Flöther, R. Schneider, et al. Best practice for perioperative management of patients with cytoreductive surgery and HIPEC Eur J Surg Oncol, 43 (2017), pp. 1013-1027

4 S. Malfroy, F. Wallet, D. Maucort-Boulch, et al. Complications after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for treatment of peritoneal carcinomatosis: Risk factors for ICU admission and morbidity prognostic score Surg Oncol, 25 (2016), pp. 6-15

5 J. Esquivel, F. Angulo, R.K. Bland, et al. Hemodynamic and Cardiac Function Parameters During Heated Intraoperative Intraperitoneal Chemotherapy Using the Open “Coliseum Technique” Ann Surg Oncol, 7 (2000), pp. 296-300

6 K. Holte, N.B. Foss, J.L. Andersen, et al. Liberal or restrictive fluid administration in fast-track colonic surgery: a randomized double-blind study Br J Anaesth, 99 (2007), pp. 500-508

7 GP Joshi Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery Anesth Analg, 101 (2005), pp. 601-605

8 B. Brandstrup, H. Tønnesen, R. Beier-Holgersen, et al. Danish Study Groupon Perioperative Fluid Therapy. Effects of intravenous fluid restriction non postoperative complications: comparison of two Perioperative fluid regimens: a randomized assessor-blinded multicentertrial Ann Surg, 238 (2003), pp. 641-648

9 V. Nisanevich, I. Felsenstein, G. Almogy, et al. Effect of intraoperative fluid management on outcome after intraabdominal surgery Anesthesiology, 103 (2005), pp. 25-32

10 O.S. Eng, S. Dumitra, M. O’Leary, et al. Association of Fluid Administration With Morbidity in Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy JAMA Surg, 152 (2017), pp. 1156-1160

11 M.T. Giglio, M. Marucci, M. Testini, et al. Goal-directed haemodynamic therapy and gastrointestinal complications in major surgery: a meta-analysis of randomized controlled trials Br J Anaesth, 103 (2009), pp. 637-646

12 L. Colantonio, C. Claroni, L. Fabrizi, et al. A randomized trial of goal directed vs. standard fluid therapy in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy J Gastrointest Surg, 19 (2015), pp. 722-729

13 T.J. Gan, A. Soppitt, M. Maroof, et al. Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery Anesthesiology, 97 (2002), pp. 820-826

14 N. Brienza, M.T. Giglio, M. Marucci, et al. Does perioperative hemodynamic optimization protect renal function in surgical patients? A meta-analytic study Crit Care Med, 7 (2009), pp. 2079-2090

15 N. MacDonald, T. Ahmad, O. Mohr, et al. Dynamic preload markers to predict fluid responsiveness during and after major gastrointestinal surgery: an observational substudy of the OPTIMISE trial Br J Anaesthesia, 114 (2015), pp. 598-604

16 K. Bouattour, J.L. Teboul, L. Varin, et al. Preload Dependence Is Associated with Reduced Sublingual Microcirculation during Major Abdominal Surgery Anesthesiology, 130 (2019), pp. 541-549

17 D. Dindo, N. Demartines, P.A. Clavien Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey Ann Surg, 240 (2004), pp. 205-213

18 W. Raue, N. Tsilimparis, A. Bloch, et al. Volume Therapy and Cardiocircular Function during Hyperthermic Intraperitoneal Chemotherapy Eur Surg Res, 43 (2009), pp. 365-372

19 C.N. Schluermann, J. Hoeppner, C. Benk, et al. Intra-abdominal pressure, Cardiac Index and vascular resistance during hyperthermic intraperitoneal chemotherapy: a prospective observational study Minerva Anestesiol, 82 (2016), pp. 160-169

20 F. Díaz, B. Erranz, A. Donoso, et al. Influence of tidal volume on pulse pressure variation and stroke volume variation during experimental intra-abdominal hypertension BMC Anesthesiol, 15 (2015), p. 127

21 C.L. Verdant, D. De Backer, A. Bruhn, et al. Evaluation of sublingual and gut mucosal microcirculation in sepsis: a quantitative analysis Crit Care Med, 37 (2009), pp. 2875-2881

22 M. Jacquet-Lagrèze, B. Allaouchiche, D. Restagno, et al. Gut and sublingual microvascular effect of esmolol during septic shock in a porcine model Crit Care, 19 (2015), p. 241

23 AF de Bruin, VN Kornmann, K van der Sloot, et al. Sidestream dark field imaging of the serosal microcirculation during gastrointestinal surgery Colorectal Dis, 18 (2016), pp. 103-110

24 J. Ripollés, Á Espinosa, R. Casans, et al. Colloids versus crystalloids in objective-guided fluid therapy, systematic review and meta-analysis. Too early or too late to draw conclusions Braz J Anesthesiol, 65 (2015), pp. 281-291

25 K. Berend, A.P. de Vries, R.O. Gans Physiological Approach to Assessment of Acid–Base Disturbances N Engl J Med, 371 (2014), pp. 14334-14345

26 British Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients. GIFTASUP. Powell-Tuck J, Gosling P, Lobo DN, et al. (Updated March 2011).

27 S.A. McCluskey, K. Karkouti, D. Wijeysundera, et al. Hyperchloremia after noncardiac surgery is independently associated with increased morbidity and mortality: a propensity-matched cohort study Anesth Analg, 117 (2013), pp. 412-421

28 A.D. Shaw, S.M. Bagshaw, S.L. Goldstein, et al. Major complications, mortality, and resource utilization after open abdominal surgery: 0.9% saline compared to Plasma-Lyte Ann Surg, 255 (2012), pp. 821-829

29 D. Kusamura, R. Baratti, B. Younan, et al. Impact of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy on systemic toxicity Ann Surg Oncol, 14 (2007), pp. 2550-2558

30 S.A. Naffouje, K.A. Tulla, R. Chorley, et al. Acute kidney injury increases the rate of major morbidities in cytoreductive surgery and HIPEC Ann Med Surg, 35 (2018), pp. 163-168
 

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