Plackett TP, Ton-That HH, Mosier MJ, Abood GJ, Kuo PC, Pappas SG. Physiologic Response to HIPEC: Sifting Through Perturbation to Identify Markers of Complications. J Am Osteopath Assoc 2017;117(1):16–23. doi: 10.7556/jaoa.2017.003.
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Context: The postoperative physiologic response to hyperthermic intraperitoneal chemotherapy (HIPEC) has been poorly studied outside of the immediate perioperative time.
Objective: To characterize the physiologic response during the first 5 days after HIPEC and identify variables associated with major complications.
Methods: Patients undergoing HIPEC and cytoreductive surgery during a 14-month interval were retrospectively identified and their records reviewed for demographics, physiologic response, and major complications. Vital signs and laboratory results were recorded before the operation, immediately after the procedure, and for the first 5 postoperative days.
Results: Thirty-three patients were included. The mean body temperature and heart rate were elevated on postoperative day 1 compared with baseline (preoperative) status (37.1°C vs 36.6°C and 103 vs 78 beats/min, respectively) and remained elevated through postoperative day 5. The mean arterial pressure was lower on postoperative day 1 (73 mm Hg) but returned to baseline on postoperative day 3 (93 mm Hg). Mean creatinine level increased on postoperative day 1 (0.96 mg/dL) but returned to baseline on postoperative day 2 (0.87 mg/dL). Fourteen patients (42%) had major complications. The strongest predictors of major complications were a prolonged operative time (519 vs 403 minutes) and extreme changes in body temperature and renal function.
Conclusions: Hyperthermic intraperitoneal chemotherapy results in a hypermetabolic response that partially returns to baseline around postoperative day 3. Elevated body temperature and impaired renal function are the best predictors of major complications.
Keywords: chemotherapy, cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, peritoneal carcinomatosis
a Data are given as mean (SD) unless otherwise indicated.
Abbreviations: BMI, body mass index; HIPEC, hyperthermic intraperitoneal chemotherapy; PCI, peritoneal carcinomatosis index.
a P value applies to overall trend over time.
Abbreviations: BUN, blood urea nitrogen; HIPEC, hyperthermic intraperitoneal chemotherapy.
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