Investigation of morbidity and mortality stay in postoperative intensive care uni̇t after cytoreductive surgery in patients with hyperthermic intraperitoneal chemotherapy

Sugarbaker was the first to define the concepts of cytoreductive surgery (CRS) and Hyperthermic intraperitoneal chemotherapy (HIPEC) in 1995. CRS and HIPEC are among the most frequently used effective multimodal treatment options in selected peritoneal carcinomatosis (PC) cases in the last 20 years. The morbidity rates of this technique range from 12% to 67.6%, while its mortality ranges from 0% to 9%. In this study, it was aimed to evaluate the effect of demographic characteristics, comorbidity, primary cancer, operative procedures (resection, anastomosis, ostomy), operative time, chemotherapeutic agents, intraoperative and postoperative vasopressor-inotropic drug use, intraoperative and postoperative blood/blood product and colloid replacement need, intubation status and invasive/non-invasive respiratory support need, perioperative hematological and metabolic changes, acute kidney injury, on hospitalization in the intensive care unit and morbidity-mortality rates in patients who underwent CRS and HIPEC in our hospital. After the approval of the Ethics Committee, the data of 53 patients who underwent CRS between 01.01.2018 and 30.09.2020 were analyzed retrospectively. In the examination, it was determined that 12 patients who underwent CRS did not have HIPEC and these patients were excluded from the study. 41 patients were included in the study. In the preoperative period, descriptive data of the patients (age, height, weight, gender, body mass index (BMI), ASA (American Society of Anesthesiologists) scores, accompanying systemic diseases, preoperative laboratory values and primary cancer were recorded. Operation procedures applied in the intraoperative period (resection, anastomosis, ostomy), operation time (CRS+HIPEC), blood and blood product replacement needs, vasopressor and inotrope use, fluids given (colloid) and chemotherapeutic agents used in the HIPEC phase were recorded. In the postoperative period, extubating status of the patients, ICU needs and length of stay in the ICU, use of vasopressors and inotropes in the ICU, invasive mechanical ventilation (re-intubation status) support, non-invasive mechanical ventilation support, blood and blood product replacement needs, albumin replacement and postoperative 24-hour laboratory values were recorded. AKIN (Acute kidney injury network) criteria were used in the evaluation of acute kidney injury (AKI). The first month mortality rate of our patients was 12.2%, consistent with the literature. We concluded that postoperative vasopressor-inotrope use and increased re-intubation rates were similarly significant in terms of one-month mortality as literature. The changes in preoperative and postoperative coagulation, complete blood count and biochemistry parameters were consistent with the literature and a statistically significant difference was observed. In conclusion, CRS and HIPEC is a difficult procedure to manage for anesthesiologists and surgeons due to perioperative hemodynamic, hematological and metabolic changes. With primary cancer, the size of the surgery and anesthetic management can affect the results. Since CRS and HIPEC is a surgical process with high morbidity and mortality, there is a need for comprehensive guidelines for patient selection and perioperative management. Keywords: Cytoreductive Surgery, Hyperthermic İntraperitoneal Chemotherapy, Morbidity, Mortality