Anesthetic management of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: A case series

Abstract

Hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment for advanced abdominopelvic malignancies with peritoneal carcinomatosis. Cytoreductive surgery (CRS) with HIPEC offers hope by increasing the survival rates of these cancers. Anesthesiologists play an important role in HIPEC and cytoreductive procedures. This report presents five cases of advanced gynecological malignancies managed with CRS and HIPEC. All patients underwent the open coliseum technique. All patients scheduled for CRS+HIPEC were International Federation of Gynaecology and Obstetrics (FIGO) stage III or higher, confirmed by positron emission tomography-computed tomography, and staging laparotomy with intraoperative biopsies. Patients were preoperatively optimized based on age, physical status, and comorbidities. General anesthesia with thoracic epidural analgesia was administered. Physiological challenges during HIPEC, including fluid shifts, temperature fluctuations, and hemodynamic alterations, were effectively managed. None of the patients developed any major post-operative complications. They were extubated on the 1st post-operative day and discharged after 10–12 days. Understanding the physiological and pathological changes during CRS+HIPEC and individualized anesthesia management is essential for successful outcomes. Appropriate patient selection and vigilant monitoring minimize complications.