Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Nov 9, 2022; 11(6): 375-386
Published online Nov 9, 2022. doi: 10.5492/wjccm.v11.i6.375
Postoperative complications and critical care management after cytoreduction surgery and hyperthermic intraperitoneal chemotherapy: A systematic review of the literature
Anjana S Wajekar, Sohan Lal Solanki, Vijaya P Patil
Anjana S Wajekar, Sohan Lal Solanki, Vijaya P Patil, Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, Maharashtra, India
Author contributions: Wajekar AS and Solanki SL helped in the literature review and writing of the manuscript; Wajekar AS, Solanki SL and Patil VP helped in editing the manuscript; all authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sohan Lal Solanki, MD, Professor, Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, 2nd Floor, Main Building, Tata Memorial Hospital, Dr E Borges Marg, Parel, Mumbai 400012, Maharashtra, India. me_sohans@yahoo.co.in
Received: March 13, 2022
Peer-review started: March 13, 2022
First decision: May 31, 2022
Revised: June 13, 2022
Accepted: September 9, 2022
Article in press: September 9, 2022
Published online: November 9, 2022
Processing time: 235 Days and 15.9 Hours
ARTICLE HIGHLIGHTS
Research background

CRS-HIPEC is an aggressive option for the comprehensive management of all peritoneal surface malignancies. It can result in some life-threatening complications in the immediate postoperative period and reported higher morbidity and mortality rates. Postoperative morbidity and survival have significantly improved. The commonest postoperative surgical complications and systemic toxicity due to chemotherapy as reported in the last decade are discussed.

Research motivation

The number of patients undergoing CRS-HIPEC has increased in the last decade as have improvements in surgical techniques, surgical skills and perioperative management strategies. All these have led to improvements in post-surgical outcomes and survival rates. The present article reviews the early postoperative management and common complications after CRS-HIPEC, reported in the last decade.

Research objectives

To review early postoperative management after CRS-HIPEC. To review common immediate post-surgical complications, namely gastrointestinal, respiratory, cardiovascular, miscellaneous and systemic toxicity secondary to chemotherapy, in these patients.

Research methods

An electronic literature search was conducted using the databases of ‘PubMed’ and ‘Google Scholar’, during the period from 2010 to 2021. Postoperative complications and their synonyms in various combinations were searched. The extracted articles were further reviewed in a step-wise manner for the identification of relevant studies. The full-text assessment identified 14 original articles regarding postoperative complications and critical care management for inclusion in the final review article.

Research results

This article reviewed the early postoperative critical care management of such patients and the immediate post-surgical complications as reported in the gamut of studies included in the final review.

Research conclusions

CRS-HIPEC is a complex surgery, with a proven postoperative systemic inflammatory response. The focus in recent years has shifted to understanding the immediate postoperative pathophysiology and its management, early detection of complications and the institution of appropriate treatment to reduce morbidity and improve survival. The implementation of ERAS guidelines specific to CRS-HIPEC should help to further reduce postoperative complications.

Research perspectives

There are two major avenues for research in this area. One is the early prediction of postoperative complications and early intervention to reduce morbidity and mortality. Although numerous inflammatory markers such as mean platelet volume, CRP, procalcitonin etc have been studied, no single test is foolproof and they should be utilized in association with the clinical scenario, microbiological and biochemical investigations. The second avenue is the implementation of ERAS guidelines for CRS-HIPEC and its impact on postoperative outcomes and survival.