Postoperative complications and critical care management after cytoreduction surgery and hyperthermic intraperitoneal chemotherapy: A systematic review of the literature.

Anjana S Wajekar, Sohan Lal Solanki, Vijaya P Patil
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引用次数: 2

Abstract

Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a comprehensive treatment option performed for peritoneal surface malignancies. Postoperatively almost all patients are transferred to the intensive care unit electively.

Aim: To describe the common and rare postoperative complications, postoperative mortality and their critical care management after CRS-HIPEC.

Methods: The authors assessed 54 articles for eligibility. Full text assessment identified 14 original articles regarding postoperative complications and critical care management for inclusion into the final review article.

Results: There is an exaggerated metabolic and inflammatory response after surgery which may be termed as physiological in view of the nature of surgery combined with the use of heated intraperitoneal chemotherapy with/out early postoperative intravenous chemotherapy. The expected postoperative course is further discussed. CRS-HIPEC is a complex procedure with some life-threatening complications in the immediate postoperative period, reported morbidity rates between 12%-60% and a mortality rate of 0.9%-5.8%. Over the years, since its inception in the 1980s, postoperative morbidity and survival have significantly improved. The commonest postoperative surgical complications and systemic toxicity due to chemotherapy as reported in the last decade are discussed.

Conclusion: CRS-HIPEC is associated with a varying rate of postoperative complications including postoperative deaths and needs early suspicion and intensive care monitoring.

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细胞减少手术和腹腔内高温化疗后的术后并发症和重症监护管理:文献的系统回顾。
背景:细胞减少手术(CRS)和腹腔热化疗(HIPEC)是腹膜表面恶性肿瘤的综合治疗选择。术后几乎所有患者都选择性转入重症监护病房。目的:探讨CRS-HIPEC术后常见和罕见并发症、术后死亡率及其重症监护处理。方法:作者对54篇文章进行了合格性评估。全文评估确定了14篇关于术后并发症和重症监护管理的原创文章,纳入最终综述文章。结果:术后代谢和炎症反应明显,结合手术性质,腹腔内加热化疗和术后早期静脉化疗,可称为生理性反应。进一步讨论预期的术后过程。CRS-HIPEC是一种复杂的手术,术后会出现一些危及生命的并发症,据报道发病率在12%-60%之间,死亡率为0.9%-5.8%。多年来,自20世纪80年代开始,术后发病率和生存率显著提高。在过去的十年中最常见的术后手术并发症和全身毒性由于化疗的报道进行了讨论。结论:CRS-HIPEC与术后并发症发生率相关,包括术后死亡,需要早期怀疑和重症监护监测。
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