Impact of intra-operative factors upon peri-operative outcomes in women undergoing hyperthermic intraperitoneal chemotherapy for gynecologic cancer

Gynecol Oncol. 2021 Apr;161(1):194-201. doi: 10.1016/j.ygyno.2021.01.006. Epub 2021 Jan 16.

Abstract

Objectives: To evaluate the incidence of intra-operative metabolic and electrolyte abnormalities and subsequent impact on peri-operative outcomes in women with gynecologic cancer undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC).

Methods: An IRB-approved single institution retrospective cohort study was performed in women with gynecologic cancer who underwent CRS + HIPEC. Patient demographics, intra-operative electrolyte and metabolic values and peri-operative outcomes were recorded. To assess the association of pH and lactate upon post-operative outcomes, patients were divided in four quartiles for both variables and univariate analysis was performed.

Results: 100 consecutive women who underwent CRS + HIPEC from 2017 to 2020 were identified. Intra-operative blood transfusion and pressor support were required in 40% and 86%, respectively. The rate of ICU admission was 17%. Longer operative time (7.0 vs. 5.3 h, p = 0.002), increased blood loss (400.0 vs. 200.0 mL, p = 0.02) and transfusion (70.6% vs. 34.1%, p = 0.005) were associated with ICU admission. Compared to patients in the highest quartile of pH, lower median pH, (7.211 vs. 7.349, p < 0.001) was associated with increased rates of ICU admission, prolonged intubation (36.0% vs. 0.0%, p < 0.05, respectively) and any post-operative complication (72.0% vs. 28.0%, p = 0.01). Similarly, need for prolonged intubation (40% vs. 0%, p = 0.04) and VTE (13.0% vs. 0%, p = 0.01) were increased in women with the highest quartile of lactate levels compared to the lowest (4.7 vs 1.9, p < 0.001).

Conclusions: Intra-operative acidosis is associated with higher incidence of ICU admission and peri-operative complications following CRS + HIPEC in women with gynecologic cancer. These data support the importance of adequate intra-operative resuscitation and timely correction of hemodynamic and metabolic abnormalities.

Keywords: HIPEC; Hyperthermic intraperitoneal chemotherapy; Neoadjuvant chemotherapy; Ovarian cancer.

MeSH terms

  • Acidosis / etiology
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Cisplatin / administration & dosage
  • Cohort Studies
  • Combined Modality Therapy
  • Cytoreduction Surgical Procedures / adverse effects
  • Cytoreduction Surgical Procedures / methods*
  • Doxorubicin / administration & dosage
  • Female
  • Genital Neoplasms, Female / therapy*
  • Humans
  • Hyperthermic Intraperitoneal Chemotherapy / adverse effects
  • Hyperthermic Intraperitoneal Chemotherapy / methods*
  • Middle Aged
  • Mitomycin / administration & dosage
  • Paclitaxel / administration & dosage
  • Perioperative Period
  • Retrospective Studies

Substances

  • Mitomycin
  • Doxorubicin
  • Paclitaxel
  • Cisplatin