Pulmonary influences on early post-operative recovery in patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy treatment: a retrospective study

World Journal of Surgical Oncology

Haile Mahteme²  Sten Rubertsson¹  Antonina Bergman³  Michael R Torkzad³  Erebouni Arakelian² 

[1] Department of Surgical Sciences, Section of Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden;Department of Surgical Sciences, Section of Surgery, Uppsala University, Uppsala, Sweden;Department of Radiology, Oncology and Radiation Science, Section of Radiology, Uppsala University, Uppsala, Sweden

关键词: Radiological assessment;    Pulmonary influences;    Post-operative recovery;    HIPEC;    CRS;    Peritoneal carcinomatosis;   

Others  :  826807
DOI  :  10.1186/1477-7819-10-258

 received in 2012-07-17, accepted in 2012-10-31,  发布年份 2012

【 摘 要 】

Background

The combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a curative treatment option for peritoneal carcinomatosis (PC). There have been few studies on the pulmonary adverse events (AEs) affecting patient recovery after this treatment, thus this study investigated these factors.

Methods

Between January 2005 and December 2006, clinical data on all pulmonary AEs and the recovery progress were reviewed for 76 patients with after CRS and HIPEC. Patients with pulmonary interventions (thoracocenthesis and chest tubes) were compared with the non-intervention patients. Two senior radiologists, blinded to the post-operative clinical course, separately graded the occurrence of pulmonary AEs.

Results

Of the 76 patients, 6 had needed thoracocentesis and another 6 needed chest tubes. There were no differences in post-operative recovery between the intervention and non-intervention groups. The total number of days on mechanical ventilation, the length of stay in the intensive care unit, total length of hospital stay, tumor burden, and an American Society of Anesthesiologists (ASA) grade of greater than 2 were correlated with the occurrence of atelectasis and pleural effusion. Extensive atelectasis (grade 3 or higher) was seen in six patients, major pleural effusion (grade 3) in seven patients, and signs of heart failure (grade 1–2) in nine patients.

Conclusions

Clinical and radiological post-operative pulmonary AEs are common after CRS and HIPEC. However, most of the pulmonary AEs did not affect post-operative recovery.

【 授权许可】

   
2012 Arakelian et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]van Leeuwen BL, Graf W, Pahlman L, Mahteme M: Swedish experience with peritonectomy and HIPEC. HIPEC in peritoneal carcinomatosis. Ann Surg Oncol 2008, 15:745-753.
• [2]Deraco M, Baratti D, Inglese MG, Allaria B, Andreola S, Gavazzi C, Kusamura S: Peritonectomy and Intraperitoneal Hyperthermic Perfusion (IPHP): a strategy that has confirmed its efficacy in patients with pseudomyxoma peritonei. Ann Surg Oncol 2004, 11:393-398.
• [3]Sugarbaker PH: Laser-mode electrosurgery. Cancer Treat Res 1996, 82:375-385.
• [4]Massarweh NN, Cosgriff N, Slakey DP: Electrosurgery: history, principles, and current and future uses. J Am Coll Surg 2006, 202:520-530.
• [5]Miao N, Pingpank JF, Alexander HR, Royal R, Steinberg SM, Quezado MM, Beresnev T, Quezado ZM2: Cytoreductive surgery and continuous hyperthermic peritoneal perfusion in patients with mesothelioma and peritoneal carcinomatosis: hemodynamic, metabolic, and anesthetic considerations. Ann Surg Oncol 2009, 16:334-344.
• [6]Esquivel J, Angulo F, Bland RK, Stephens AD, Sugarbaker PH: Hemodynamic and cardiac function parameters during heated intraoperative intraperitoneal chemotherapy using the open “coliseum technique”. Ann Surg Oncol 2000, 7:296-300.
• [7]Schmidt C, Moritz S, Rath S, Grossmann E, Wiesenack C, Piso P, Graf BM, Bucher M: Perioperative management of patients with cytoreductive surgery for peritoneal carcinomatosis. J Surg Oncol 2009, 100:297-301.
• [8]Raue W, Tsilimparis N, Bloch A, Menenakos C, Hartmann J: Volume therapy and cardio circular function during hyperthermic intraperitoneal chemotherapy. Eur Surg Res 2009, 43:365-372.
• [9]Rankovic VI, Masirievic VP, Pavlov MJ, Ceranic MS, Milenkovic MG, Simic AP, Kecmanovic DM: Hemodynamic and cardiovascular problems during modified hypertermic intraperitoneal perioperative chemotherapy. Hepatogastroenterology 2007, 54:364-366.
• [10]Eltabbakh GH, Awtrey CS, Walker P: Adult respiratory distress syndrome after extensive cytoreductive surgery. A case report. J Reprod Med 2000, 45:51-54.
• [11]Schmidt C, Creutzenberg M, Piso P, Hobbhahn J, Bucher M: Peri-operative anaesthetic management of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Anaesthesia 2008, 63:389-395.
• [12]Arakelian E, Gunningberg L, Larsson J, Norlén K, Mahteme H: Factors influencing early postoperative recovery after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Eur J Surg Oncol 2011, 37:897-903.
• [13]National Cancer Institute: Common Terminology Criteria for Adverse Events v3.0 (CTCAE). http://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/ctcaev3.pdf webcite
• [14]Alonso O, Sugarbaker PH: Adult respiratory distress syndrome occurring in two patients undergoing cytoreductive surgery plus perioperative intraperitoneal chemotherapy: case reports and a review of the literature. Am Surg 2000, 66:1032-1036.
• [15]World Medical Association Declaration of Helsinki 1964. http://www.wma.net/en/30publications/10policies/b3/index.html webcite
• [16]Cancer Research UK: WHO performance status. http://www.cancerhelp.org.uk/about-cancer/cancer questions/performance-status webcite
• [17]Sugarbaker PH: Peritonectomy procedures. Ann Surg 1995, 221:29-42.
• [18]Jacquet P, Sugarbaker PH: Current methodologies for clinical assessment of patients with peritoneal carcinomatosis. J Exp Clin Cancer Res 1996, 15:49-58.
• [19]Allvin R: Postoperative recovery. Development of a Multi-dimensional Questionnaire for Assessment of Recovery. In PhD thesis. Sweden: Orebro University, Department of Clinical Medicine; 2009.
• [20]Duggan M, Kavanagh BR: Atelectasis in the perioperative patient. Curr Opin Anaesthesiol 2007, 20:37-42.
• [21]Usta E, Mustafi M, Ziemer G: Ultrasound estimation of volume of postoperative pleural effusion in cardiac surgery patients. Interact Cardiovasc Thorac Surg 2010, 10:204-207.
• [22]Reinius H, Jonsson L, Gustafsson S, Sundbom M, Duvernoy O, Pelosi P, Hedenstierna G, Fredén F: Prevention of atelectasis in morbidly obese patients during general anesthesia and paralysis. Anesthesiology 2009, 111:979-987.
• [23]Casado D, López F, Marti R: Perioperative fluid management and major respiratory complications in patients undergoing esophagectomy. Dis Esophagus 2010, 23:523-528.
• [24]Kita T, Mammoto T, Kishi Y: Fluid management and postoperative respiratory disturbances in patients with transthoracic esophagectomy for carcinoma. J Clin Anesth 2002, 14:252-256.
• [25]Warner GC, Cox GJ: Evaluation of chest radiography versus chest computed tomography in screening for pulmonary malignancy in advanced head and neck cancer. J Otolaryngol 2003, 32:107-109.
• [26]Kang EY, Staples CA, McGuinness G, Primack SL, Müller NL: Detection and differential diagnosis of pulmonary infections and tumors in patients with AIDS: value of chest radiography versus CT. AJR Am J Roentgenol 1996, 166:15-19.
• [27]Woodring JH, Reed JC: Types and mechanisms of pulmonary atelectasis. J Thorac Imaging 1996, 11:92-108.