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Restrictive Intraoperative Fluid Therapy is Associated with Decreased Morbidity and Length of Stay Following Hyperthermic Intraperitoneal Chemoperfusion

  • Peritoneal Surface Malignancy
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Recent data have demonstrated multiple benefits of intra- and postoperative fluid restriction in major abdominal surgery; however, data regarding the outcomes of fluid restriction in cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion (CRS/HIPEC) are limited. This study evaluates the safety and short-term clinical outcomes of restricted intraoperative fluid therapy in CRS/HIPEC.

Methods

This was a single-institution, retrospective review of all CRS/HIPEC procedures performed at the University of Massachusetts Medical School between January 2009 and July 2017. Recorded variables included demographics, intraoperative factors, 60-day postoperative complications, and length of stay (LOS). Outcomes based on the use of intraoperative permissive fluid therapy (PFT) versus restrictive fluid therapy (RFT) were compared.

Results

Overall, 169 CRS/HIPEC cases were performed during the study period; 84 were managed with PFT and 85 were managed with RFT. No significant differences were identified in patient demographics. There was a decrease in intraoperative administration of crystalloid (8.0 vs. 4.4 L, p < 0.01), colloid (900 vs. 300 mL, p < 0.01), and blood transfusion (0.26 vs. 0.04 units, p < 0.01) in the RFT cohort. LOS was reduced from 11.5 to 9.7 days (p < 0.01) and the incidence of any 60-day complication decreased from 45 to 28% (p = 0.02) in the RFT group. The overall 90-day mortality rate was 0.6% (n = 1). Adjusted logistic regression demonstrated the odds of having a Clavien–Dindo grade III or higher complication was 0.31 (95% confidence interval 0.10–0.95) with RFT.

Conclusion

Intraoperative RFT with standard anesthesia monitoring devices can be safely used in CRS/HIPEC and is associated with a decreased LOS and decreased rate of postoperative complications.

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Acknowledgements

The data for this research were provided by the Cancer Research Office of the University of Massachusetts Medical Center. Funding for this study was provided by the Division of Surgical Oncology at the University of Massachusetts Medical School.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA

    Ryan J. Hendrix MD, Chloe Williams MD, Ariana Harris BS & Laura A. Lambert MD, FACS

  2. Section of Colon and Rectal Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA

    Aneel Damle MD

  3. Division of Perioperative Medicine, University of Massachusetts Medical School, Worcester, MA, USA

    Spiro Spanakis MD

  4. Department of Anesthesiology, Boston University School of Medicine, Boston, MA, USA

    Donald H. Lambert PhD, MD

  5. Peritoneal Surface Malignancy Program, Section of Surgical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA

    Laura A. Lambert MD, FACS

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  1. Ryan J. Hendrix MD
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Corresponding author

Correspondence to Laura A. Lambert MD, FACS.

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Disclosures

Ryan J. Hendrix, Aneel Damle, Chloe Williams, Ariana Harris, Spiro Spanakis, Donald H. Lambert, and Laura A. Lambert do not have any disclosures to declare.

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Hendrix, R.J., Damle, A., Williams, C. et al. Restrictive Intraoperative Fluid Therapy is Associated with Decreased Morbidity and Length of Stay Following Hyperthermic Intraperitoneal Chemoperfusion. Ann Surg Oncol 26, 490–496 (2019). https://doi.org/10.1245/s10434-018-07092-y

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  • DOI: https://doi.org/10.1245/s10434-018-07092-y

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