Vol 8-1 Original Research Article

Anesthetic Aspects of Cytoreductive Surgery and Hyperthermic Intrathoracic Chemotherapy (HITHOC) in Treatment of Pleural Malignancies - Experiences from IORS

Ana Cvetkovic MD PhD1,3*, Dejan Stojiljkovic MD Phd2,3*, Dijana Mircic MD PhD1*, Nada Santrac MD PhD2,3, Milan Zegarac MD PhD2,3, Andrej Jokic MD1, Lazar Glisic MD PhD4

1Department of Anesthesiology with Reanimatology and Intensive Care Unit, Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia

2Department of Surgery, Surgical Oncology Clinic, institute for Oncology and Radiology of Serbia, Belgrade, Serbia

3Medical School, University of Belgrade, Belgrade, Serbia

4University Hospital for Obstetrics and Gynecology, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany

*All authors contributed equally as first authors

Background: Cytoreductive surgery (CRS) with hyperthermic intrathoracic chemotherapy (HITHOC) is a procedure that includes surgical removal of all visible tumor implants and intrathoracic application of gradually heated cytostatic solution. Numerous changes in hemodynamic, respiratory, core body temperature and metabolic parameters are possible during this complex procedure. The aim of this retrospective study was to analyze pathophysiological changes which occur during CRS + HITHOC procedure, and to suggest efficient strategies for perioperative patient care that might reduce complication rate.

Methods: The study included 7 patients who underwent CRS + HITHOC in our cancer center. Enhanced Recovery After Surgery (ERAS) guideline for Thoracic Surgery was applied to all patients. Data on intraoperative hemodynamics (mean arterial pressure, stroke volume, heart rate, cardiac output) and temperature variations were collected from medical records and analyzed in three timelines: during the CRS phase, at the beginning, and the end of cytostatic perfusion. Occurrence of respiratory, renal, and cardiac complications was monitored.

Results: All patients were respiratory stable during one-lung ventilation, with adequate gas exchange. Hemodynamic stability was compromised at the beginning of cytostatic perfusion, with significant decrease of mean arterial pressure and stroke volume. Two patients required vasopressor support. Average core body temperature was satisfactory in all patients. Coagulation disorders and acute renal failure were not recorded in postoperative period. One patient developed atrial fibrillation which was successfully pharmacologically restored.

Conclusion: Our results indicate that goal directed fluid management following ERAS protocol, with maintaining hemodynamic stability and normothermia, could prevent perioperative complications during HITHOC procedure.

DOI: 10.29245/2578-2967/2024/1.1204 View / Download Pdf