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Association between intraoperative vascular filling and outcomes in patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy
Position du problème et objectif(s) de l’étude
Data on perioperative factors associated with outcomes in patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS with HIPEC) remain limited. This study aimed to evaluate the association between intraoperative resuscitation and outcomes in patients undergoing CRS with HIPEC.
Matériel et méthodes
Single center, observational and retrospective study approved by local ethics committee (IRB 00010254 - 2019 - 203) and conducted in accordance with the STROBE guidelines. Data were extracted from electronic health record. The primary outcome was the Comprehensive Complication Index (CCI) at 28 days after surgery. Secondary outcomes were occurrence of complications, ICU length of stay and mortality at 28 days after surgery. P<0.05 was considered statistically significant.
Résultats & Discussion
A total of 127 patients were included between January 2019 to June 2024 (Table 1). The median CCI at day 28 was 21 (0, 31). The median intraoperative fluid volume administered was 14.2 (11.5-18.6) ml/kg/h, and was higher in the group High CCI group vs. Low CCI group (15.4 (12-21.2) ml/kg/h vs. 13.1 (10.7-15.9) ml/kg/h (p=0.028), respectively). Multivariate analysis adjusting for prior surgery, PCI, number of resections, length of surgery and intraoperative bleeding, identified high intraoperative fluid administration as an independent factor associated with a higher CCI (OR 1.93; 95% CI, 1.22- 3.03; p =0.005). A greater positive fluid balance on postoperative day 1 after CRS + HIPEC was observed in the group experiencing a higher rate of postoperative complications (respectively 21 (9-33) vs. 12 (6-22) ml/kg/h; p= 0.011).
Conclusion
In patients undergoing CRS with HIPEC, a liberal fluid regimen was associated with poorer outcomes at 28 days after surgery. Future studies should explore the potential benefits of a restrictive fluid administration strategy, guided by hemodynamic monitoring or the use of colloids.
Auteurs
Rania MHENNI (1) , Emmanuel DUDOIGNON (1), Arthur MOREAU (1), Diane GOÉRÉ (1), Benoit PLAUD (1), François DÉPRET (2), Benjamin DENIAU (2) - (1)Hôpital Saint-Louis, Paris, France, (2)Hôpital Saint-Louis - Paris (France), Paris, France