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- Title
Association of Fluid Administration With Morbidity in Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy.
- Authors
Eng, Oliver S.; Dumitra, Sinziana; O'Leary, Michael; Raoof, Mustafa; Wakabayashi, Mark; Dellinger, Thanh H.; Han, Ernest S.; Lee, Stephen J.; Paz, I. Benjamin; Lee, Byrne
- Abstract
<bold>Importance: </bold>Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal cancers can be associated with significant complications. Randomized trials have demonstrated increased morbidity with liberal fluid regimens in abdominal surgery.<bold>Objective: </bold>To investigate the association of intraoperative fluid administration and morbidity in patients undergoing CRS/HIPEC.<bold>Design, Setting, and Participants: </bold>A retrospective analysis of information from a prospectively collected institutional database was conducted at a National Cancer Institute-designated comprehensive cancer center. A total of 133 patients from April 15, 2009, to June 23, 2016, with primary or secondary peritoneal cancers were included.<bold>Exposures: </bold>Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.<bold>Main Outcomes and Measures: </bold>Morbidity associated with intraoperative fluid management calculated by the comprehensive complication index, which uses a formula combining all perioperative complications and their severities into a continuous variable from 0 to 100 in each patient.<bold>Results: </bold>Of the 133 patients identified, 38% and 37% had diagnoses of metastatic appendiceal and colorectal cancers, respectively. Mean age was 54 (interquartile range [IQR], 47-64) years, and mean peritoneal cancer index was 13 (IQR, 7-18). Mitomycin and platinum-based chemotherapeutic agents were used in 96 (72.2%) and 37 (27.8%) of the patients, respectively. Mean intraoperative fluid (IOF) rate was 15.7 (IQR, 11.3-18.7) mL/kg/h. Mean comprehensive complication index (CCI) was 26.0 (IQR, 8.7-36.2). On multivariate analysis, age (coefficient, 0.32; 95% CI, 0.01-0.64; P = .04), IOF rate (coefficient, 0.97; 95% CI, 0.19-1.75; P = .02), and estimated blood loss (coefficient, 0.02; 95% CI, 0.01-0.03; P = .002) were independent predictors of increased CCI. In particular, patients who received greater than the mean IOF rate experienced a 43% increase in the CCI compared with patients who received less than the mean IOF rate (31.5 vs 22.0; P = .02).<bold>Conclusions and Relevance: </bold>Intraoperative fluid administration is associated with a significant increase in perioperative morbidity in patients undergoing CRS/HIPEC. Fluid administration protocols that include standardized restrictive fluid rates can potentially help to mitigate morbidity in patients undergoing CRS/HIPEC.
- Subjects
ANTINEOPLASTIC agents; PERITONEUM tumors; FLUID therapy; INTRAOPERATIVE care; SURGICAL complications; THERMOTHERAPY; RETROSPECTIVE studies; CYTOREDUCTIVE surgery; TUMOR treatment
- Publication
JAMA Surgery, 2017, Vol 152, Issue 12, p1156
- ISSN
2168-6254
- Publication type
journal article
- DOI
10.1001/jamasurg.2017.2865