Effect of perioperative variables on postoperative outcome after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: retrospective analysis in a tertiary cancer center

Abstract

Author(s): Joona Prabhakaran, Sonali Opneja, Mayan John, Riyas. M

Introduction: Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) have emerged as the treatment of choice for peritoneal carcinomatosis. There is limited literature on the postoperative complications after CRS and HIPEC from the developing world. Aim: Our study aims to find out the incidence of postoperative complications after CRS and HIPEC and retrospectively analyzed the association of various perioperative anaesthetic factors with these complications. Methodology: Records of patients >18 years who underwent CRS and HIPEC in our institute from September 2018 to July 2023 were collected and data was analyzed retrospectively. Demographic details, details about extent of resection and intraoperative anesthetic events were collected. Incidence of pulmonary and cardiac complications, liver failure and renal failure were analyzed. Patients were followed up retrospectively to assess the 30day mortality. Postoperative complications were graded according to Clavien Dindo grading. Result: Cardiac complications were the most common postoperative complication followed by pulmonary then renal complications. There is also significant association between pulmonary complications and duration of surgery, transfusion of crystalloids and fresh frozen plasma. Duration of surgery, amount of blood loss, transfusion of Fresh Frozen Plasma (FFP) and platelets, intraoperative metabolic acidosis and Peritoneal Carcer Index (PCI) score were significantly associated with the development of postoperative cardiac complications. In our study, 30-day mortality was 4.7% (2/43). Conclusion: Pulmonary and cardiac complications were the two common morbidities in the postoperative period following CRS and HIPEC. Duration of surgery, transfusion of FFPs, intraoperative acidosis and PCI scoring of the disease are the major predictors of postoperative cardiac and pulmonary complications. Incidence of complications are quite high according to Clavien Dindo grading.

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