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HIPEC

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Anesthesia for Oncological Surgery

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Abstract

Peritoneal carcinomatosis (PC) is divided into primary and secondary peritoneal involvement. Primary PC is termed malignant peritoneal mesothelioma (MPM), which originates from peritoneal transformed mesothelial cells. Secondary involvement is from dissemination spread of tumor cells from other malignancies (Dahdaleh et al., Am J Surg. 224(1 Pt B):459–464, 2022; Gabriel et al., Ann Surg Oncol. 30:2506–2507, 2023). Treatment of PSM includes multimodal strategies of systemic chemotherapy, multi-visceral resections to achieve surgical cytoreduction (CRS) of macroscopic disease, and heated intraperitoneal chemotherapy (HIPEC) to tackle microscopic disease. Collectively, CRS/HIPEC is utilized to prolong 5-year survival, increase quality of life of up to 40%, and is considered the standard of care in selected patients (Foster et al., JAMA Netw Open. 2(1):e186847, 2019; Bushati et al., Ejso, 44(12):1942–1948, 2018; Valenzuela et al., Ann Surg Oncol. 29(6):3436–3445, 2022). Herein, we discuss perioperative anesthesia considerations, key surgical steps, and common postoperative complications.

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References

  1. Dahdaleh FS, et al. Potential evidence of peritoneal recurrence in Stage-II colon cancer from the control arm of CALGB9581. Am J Surg. 2022;224(1 Pt B):459–64.

    Article  PubMed  Google Scholar 

  2. Gabriel RA, Sindayigaya R, Ouaissi M, Buggisch JR, Schmeding M, Giger-Pabst U, et al. ASO visual abstract: safety and feasibility of high pressure/high dose pressurized intraperitoneal aerosol chemotherapy (HP/HD-PIPAC) for primary and metastatic peritoneal surface malignancies. Ann Surg Oncol. 2023;30:2506–7. https://doi.org/10.1245/s10434-022-12910-5.

    Article  PubMed  Google Scholar 

  3. Gregory SN, Sarvestani AL, Blakely AM. Malignant peritoneal mesothelioma literature review: past, present, and future. Dig Med Res. 2022;5:29. https://doi.org/10.21037/dmr-22-1.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Burg L, Timmermans M, van der Aa M, Boll D, Rovers K, de Hingh I, et al. Incidence and predictors of peritoneal metastases of gynecological origin: a population-based study in The Netherlands. J Gynecol Oncol. 2020;31(5):e58. https://doi.org/10.3802/jgo.2020.31.e58.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Thomassen I, van Gestel YR, van Ramshorst B, Luyer MD, Bosscha K, Nienhuijs SW, et al. Peritoneal carcinomatosis of gastric origin: a population-based study on incidence, survival and risk factors: peritoneal carcinomatosis of gastric origin. Int J Cancer. 2014;134(3):622–8. https://doi.org/10.1002/ijc.28373.

    Article  CAS  PubMed  Google Scholar 

  6. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49. https://doi.org/10.3322/caac.21660.

    Article  PubMed  Google Scholar 

  7. Segelman J, Granath F, Holm T, Machado M, Mahteme H, Martling A. Incidence, prevalence and risk factors for peritoneal carcinomatosis from colorectal cancer. Br J Surg. 2012;99(5):699–705. https://doi.org/10.1002/bjs.8679.

    Article  CAS  PubMed  Google Scholar 

  8. Foster JM, Sleightholm R, Patel A, Shostrom V, Hall B, Neilsen B, et al. Morbidity and mortality rates following cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy compared with other high-risk surgical oncology procedures. JAMA Netw Open. 2019;2(1):e186847. https://doi.org/10.1001/jamanetworkopen.2018.6847.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bushati M, et al. The current practice of cytoreductive surgery and HIPEC for colorectal peritoneal metastases: results of a worldwide web-based survey of the Peritoneal Surface Oncology Group International (PSOGI). Ejso. 2018;44(12):1942–8.

    Article  CAS  PubMed  Google Scholar 

  10. Valenzuela CD, et al. Repeat cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for cancers with peritoneal metastasis: a 30-year institutional experience. Ann Surg Oncol. 2022;29(6):3436–45.

    Article  PubMed  PubMed Central  Google Scholar 

  11. van Baal JOAM, Van de Vijver KK, Nieuwland R, van Noorden CJF, van Driel WJ, Sturk A, et al. The histophysiology and pathophysiology of the peritoneum. Tissue Cell. 2017;49(1):95–105. https://doi.org/10.1016/j.tice.2016.11.004.

    Article  PubMed  Google Scholar 

  12. Mikuła-Pietrasik J, Uruski P, Tykarski A, Książek K. The peritoneal “soil” for a cancerous “seed”: a comprehensive review of the pathogenesis of intraperitoneal cancer metastases. Cell Mol Life Sci. 2018;75(3):509–25. https://doi.org/10.1007/s00018-017-2663-1.

    Article  CAS  PubMed  Google Scholar 

  13. Lemoine L, Sugarbaker P, Van der Speeten K. Pathophysiology of colorectal peritoneal carcinomatosis: role of the peritoneum. World J Gastroenterol. 2016;22(34):7692–707. https://doi.org/10.3748/wjg.v22.i34.7692.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Maccaroni E, Giampieri R, Lenci E, Scortichini L, Bianchi F, Belvederesi L, et al. BRCA mutations and gastrointestinal cancers: when to expect the unexpected? World J Clin Oncol. 2021;12(7):565–80. https://doi.org/10.5306/wjco.v12.i7.565.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Pastorino S, Yoshikawa Y, Pass HI, et al. A subset of mesotheliomas with improved survival occurring in carriers of BAP1 and other germline mutations. J Clin Oncol. 2018;36(35):JCO2018790352. https://doi.org/10.1200/JCO.2018.79.0352.

    Article  PubMed  Google Scholar 

  16. Pietragalla A, Arcieri M, Marchetti C, Scambia G, Fagotti A. Ovarian cancer predisposition beyond BRCA1 and BRCA2 genes. Int J Gynecol Cancer. 2020;30(11):1803–10. https://doi.org/10.1136/ijgc-2020-001556.

    Article  PubMed  Google Scholar 

  17. Li J, Yan R, Lei J, Jiang C. Comparison of PET with PET/CT in detecting peritoneal carcinomatosis: a meta-analysis. Abdom Imaging. 2015;40(7):2660–6. https://doi.org/10.1007/s00261-015-0418-8.

    Article  PubMed  Google Scholar 

  18. Wang W, Tan GHC, Chia CS, Skanthakumar T, Soo KC, Teo MCC. Are positron emission tomography-computed tomography (PET-CT) scans useful in preoperative assessment of patients with peritoneal disease before cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)? Int J Hyperth. 2018;34(5):524–31. https://doi.org/10.1080/02656736.2017.1366554.

    Article  Google Scholar 

  19. Patel CM, Sahdev A, Reznek RH. CT, MRI and PET imaging in peritoneal malignancy. Cancer Imaging. 2011;11(1):123–39. https://doi.org/10.1102/1470-7330.2011.0016.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Carpelan-Holmström M, Louhimo J, Stenman UH, Alfthan H, Haglund C. CEA, CA 19-9 and CA 72-4 improve the diagnostic accuracy in gastrointestinal cancers. Anticancer Res. 2002;22(4):2311–6.

    PubMed  Google Scholar 

  21. von Breitenbuch P, Boerner T, Jeiter T, Piso P, Schlitt HJ. Laparoscopy as a useful selection tool for patients with prior surgery and peritoneal metastases suitable for multimodality treatment strategies. Surg Endosc. 2018;32(5):2288–94. https://doi.org/10.1007/s00464-017-5923-0.

    Article  Google Scholar 

  22. Ghabra S, Desale S, Sugarbaker PH. Clinical and histopathologic features of 35 patients treated for colorectal peritoneal metastases who survived 5 years. Dis Colon Rectum. 2023;66:1329–38. https://doi.org/10.1097/DCR.0000000000002448.

    Article  PubMed  Google Scholar 

  23. Sugarbaker PH, Ghabra S. Protocols versus practice in the management of colorectal peritoneal metastases. J Surg Oncol. 2022;125(8):1200–1. https://doi.org/10.1002/jso.26848.

    Article  PubMed  Google Scholar 

  24. Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res. 1996;82:359–74. https://doi.org/10.1007/978-1-4613-1247-5_23.

    Article  CAS  PubMed  Google Scholar 

  25. Elzarkaa AA, Shaalan W, Elemam D, Mansour H, Melis M, Malik E, et al. Peritoneal cancer index as a predictor of survival in advanced stage serous epithelial ovarian cancer: a prospective study. J Gynecol Oncol. 2018;29(4):e47. https://doi.org/10.3802/jgo.2018.29.e47.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Lin E-K, Hsieh M-C, Chen C-H, Lu Y-J, Wu S-Y. Outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal cancer with peritoneal metastasis. Medicine (Baltimore). 2016;95(52):e5522. https://doi.org/10.1097/md.0000000000005522.

    Article  PubMed  Google Scholar 

  27. Friedrich M, Zinn W, Kolnsberg L, Kraft C, Kuhn W. Hyperthermic intraperitoneal chemotherapy (HIPEC) for ovarian cancer: evaluation of side effects in a single institution cohort. Anticancer Res. 2020;40(3):1481–6. https://doi.org/10.21873/anticanres.14092.

    Article  CAS  PubMed  Google Scholar 

  28. Lemoine L, Sugarbaker P, Van der Speeten K. Drugs, doses, and durations of intraperitoneal chemotherapy: standardising HIPEC and EPIC for colorectal, appendiceal, gastric, ovarian peritoneal surface malignancies and peritoneal mesothelioma. Int J Hyperth. 2017;33(5):582–92. https://doi.org/10.1080/02656736.2017.1291999.

    Article  CAS  Google Scholar 

  29. Piso P, Nedelcut SD, Rau B, Königsrainer A, Glockzin G, Ströhlein MA, et al. Morbidity and mortality following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: data from the DGAV StuDoQ registry with 2149 consecutive patients. Ann Surg Oncol. 2019;26(1):148–54. https://doi.org/10.1245/s10434-018-6992-6.

    Article  PubMed  Google Scholar 

  30. Tan GHC, Ong WS, Chia CS, Tham CK, Soo KC, Teo MCC. Does early post-operative intraperitoneal chemotherapy (EPIC) for patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) make a difference? Int J Hyperth. 2016;32(3):281–8. https://doi.org/10.3109/02656736.2015.1135485.

    Article  CAS  Google Scholar 

  31. Manzullo EF, Sahai SK, Weed HG. Preoperative evaluation and management of patients with cancer. UpToDate. 2022.

    Google Scholar 

  32. Harper MM, Kim J, Pandalai PK. Current trends in cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal disease from Appendiceal and Colorectal Malignancies. J Clin Med. 2022;11(10):2840.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Gupta N, et al. Anesthetic implications in hyperthermic intraperitoneal chemotherapy. J Anaesthesiol Clin Pharmacol. 2019;35(1):3–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Kearsley R. Anesthesia for cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC). 2018. www.wfsahq.org. [cited ATOTW 349; 1–7].

  35. Hubner M, et al. Guidelines for perioperative care in cytoreductive surgery (CRS) with or without hyperthermic IntraPEritoneal chemotherapy (HIPEC): enhanced recovery after surgery (ERAS(R)) society recommendations—part I: preoperative and intraoperative management. Eur J Surg Oncol. 2020;46(12):2292–310.

    Article  PubMed  Google Scholar 

  36. Kanda M. Preoperative predictors of postoperative complications after gastric cancer resection. Surg Today. 2020;50(1):3–11.

    Article  PubMed  Google Scholar 

  37. Garg R, Bhatnagar S. Textbook of onco-anesthesiology. 1st ed. Singapore: Springer Singapore; 2021.

    Book  Google Scholar 

  38. Whelton PK, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and Management of High Blood Pressure in adults: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol. 2018;71(19):e127–248.

    Article  PubMed  Google Scholar 

  39. Bezu L, et al. Haemodynamic management during hyperthermic intraperitoneal chemotherapy: a systematic review. Anaesth Crit Care Pain Med. 2020;39(4):531–42.

    Article  PubMed  Google Scholar 

  40. Paulo J, et al. Cytoreductive surgery with Hyperthermic intraperitoneal chemotherapy: analysis of perioperative risk factors and impact on outcome. Cureus. 2022;14(3):e22937.

    PubMed  PubMed Central  Google Scholar 

  41. Guerra-Londono CE, et al. The role of hyperthermia in the treatment of peritoneal surface malignancies. Curr Oncol Rep. 2022;24(7):875–87.

    Article  CAS  PubMed  Google Scholar 

  42. Patel K, et al. Analgesia for gynecologic oncologic surgeries: a narrative review. Curr Pain Headache Rep. 2022;26(1):1–13.

    Article  PubMed  Google Scholar 

  43. Tejedor A, et al. Feasibility and effectiveness of opioid-free anesthesia in cytoreductive surgery with or without heated intraperitoneal chemotherapy. J Surg Oncol. 2022;125(8):1277–84.

    Article  CAS  PubMed  Google Scholar 

  44. Hubner M, et al. Guidelines for perioperative care in cytoreductive surgery (CRS) with or without hyperthermic IntraPEritoneal chemotherapy (HIPEC): enhanced recovery after surgery (ERAS(R)) society recommendations—part II: postoperative management and special considerations. Eur J Surg Oncol. 2020;46(12):2311–23.

    Article  PubMed  Google Scholar 

  45. Liesenfeld LF, et al. HIPEC-induced acute kidney injury: a retrospective clinical study and preclinical model. Ann Surg Oncol. 2022;29(1):139–51.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    Shadin Ghabra & Andrew M. Blakely

  2. Department of Perioperative Medicine, National Institutes of Health, Bethesda, MD, USA

    Andrew Mannes & Ning Miao

Authors
  1. Shadin Ghabra
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  2. Andrew M. Blakely
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  3. Andrew Mannes
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  4. Ning Miao
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Corresponding author

Correspondence to Shadin Ghabra .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Moffitt Cancer Center, Tampa, FL, USA

    Jeffrey Huang

  2. Department of Anesthesiology, University of Louisville Hospital, Louisville, KY, USA

    Jiapeng Huang

  3. Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA

    Henry Liu

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Ghabra, S., Blakely, A.M., Mannes, A., Miao, N. (2023). HIPEC. In: Huang, J., Huang, J., Liu, H. (eds) Anesthesia for Oncological Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-50977-3_42

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  • DOI: https://doi.org/10.1007/978-3-031-50977-3_42

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