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Evaluating the Impact of Total Intravenous Anesthesia on the Clinical Outcomes and Perioperative NLR and PLR Profiles of Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to assess the impact of total intravenous anesthesia (TIVA) on the perioperative inflammatory profile and clinical outcomes of patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS–HIPEC).

Methods

A retrospective review of patients undergoing CRS–HIPEC was performed. Patients receiving a combination of preoperative tramadol extended release (ER), celecoxib, and pregabalin, along with combined intraoperative infusions of propofol, dexmedetomidine, lidocaine, and ketamine were classified as receiving a TIVA regimen (TIVA group). The second group consisted of patients receiving volatile–opioid-based anesthesia (VO group). The neutrophil:leukocyte (NLR) and platelet: leukocyte (PLR) ratios were calculated to evaluate the perioperative inflammatory status of both groups. Length of stay (LOS) and complications of both groups were also evaluated.

Results

A total of 213 patients were included in the study—139 in the VO group and 74 in the TIVA group. No statistically significant differences were observed between the groups with regard to their postoperative inflammatory profiles, LOS, or complications by organ system; however, the incidence of renal complications was higher in the TIVA group (8.1 vs. 2.2 %) and approached statistical significance (p = 0.068).

Conclusions

In this retrospective study of patients undergoing CRS–HIPEC, the combined use of preoperative celecoxib, tramadol ER and pregabalin followed by intraoperative TIVA with infusions of propofol, dexmedetomidine, ketamine, and lidocaine was not associated with a reduction in LOS or complications by organ system. Postoperative NLR and PLR profiles were also not significantly impacted.

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Disclosure

Pascal Owusu-Agyemang, Juan P. Cata, Keith F. Fournier, Acsa M. Zavala, Jose Soliz, Mike Hernandez, Andrea Hayes-Jordan, and Vijaya Gottumukkala have no conflicts of interest to declare.

Funding

This study was not funded.

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Authors and Affiliations

  1. Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Pascal Owusu-Agyemang MD, Juan P. Cata MD, Acsa M. Zavala MD, Jose Soliz MD & Vijaya Gottumukkala MD

  2. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Keith F. Fournier MD & Andrea Hayes-Jordan MD

  3. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Mike Hernandez MS

  4. Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA

    Juan P. Cata MD

Authors
  1. Pascal Owusu-Agyemang MD
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  2. Juan P. Cata MD
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Correspondence to Pascal Owusu-Agyemang MD.

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Owusu-Agyemang, P., Cata, J.P., Fournier, K.F. et al. Evaluating the Impact of Total Intravenous Anesthesia on the Clinical Outcomes and Perioperative NLR and PLR Profiles of Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 23, 2419–2429 (2016). https://doi.org/10.1245/s10434-016-5176-5

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  • DOI: https://doi.org/10.1245/s10434-016-5176-5

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