Anesthetic management of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy procedures

Abstract

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy procedure are performed with increasing frequency to treat patients with diffused peritoneal carcinomatosis. These procedures have showed to increase life expectancy in what was previously considered a “terminal condition”. Anyway patients face major and life threatening derangements of their hemodynamic, respiratory and metabolic physiologic balance during the surgery and in the immediate postoperative period. Despite the need of an advanced organ monitoring and support all these derangements seem to be mild and short-lived when timely addressed, at least in the majority of patients. Intensive care physicians are involved in providing surveillance and organ support till the patient is effectively weaned after the operation. Moreover, the anesthesiologist as perioperative physician is involved in pain control, metabolic and nutritional support of this cohort of patients. This task can be challenging considering that part of the patients are already on a long list of pain control medication after previous surgery or chemotherapy. A malnourished state is common too and it is secondary to difficult feeding, wasting syndrome from the tumor and massive ascites. The last issue the anesthesiologists need to be aware of is the impact over the quality of life (QoL) of this procedure. The patient’s underlying pathology is unlikely to be definitively cured so no treatment is an acceptable choice. The possibility to withhold the treatments must be part of the consultation process like the discussion about the QoL in the immediate, as well as in the long-term, after the operation. Careful monitoring and treatment of every aspect that can impact the QoL must be taken and the efforts to be poured into an effective preservation of the QoL must be doubled when compared with a patient scheduled for major abdominal surgery.

Keywords: Peritoneal carcinomatosis, Anesthesia, Hyperthermic intraperitoneal chemotherapy, Morbidity, Mortality

Core tip: The strenght of this review is to be part of an editorial project that addresses all the aspects of hyperthermic intraperitoneal chemotherapy and cytoreductive surgery procedure. As last article of this special number it gives a comprehensive overview of the anestesiologic issues and an in-depth view of the perioperative problems and how they affect life and quality of of the patients that undergone this type of surgery. Moreover for every topic preoperative, intraoperative and postoperative considerations are provided in order to give a clear guide to the physician that approchese these patients.