Inflammatory response and optimalisation of perioperative fluid administration during hyperthermic intraoperative intraperitoneal chemotherapy surgery

Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment option for selected patients with peritoneal carcinomatosis. Unfortunately, this procedure has a high incidence of postoperative complications (1,2). HIPEC only little contributes to the morbidity and mortality which are more dependent on the surgery itself (3). Inadequate intraoperative volume therapy is a known risk factor for complications. Previous studies have documented haemodynamic changes associated with HIPEC, but the optimal strategy for patient management during administration of intraperitoneal chemotherapy is unclear (4-6). Critical evaluation of fluid status is challenging in patients undergoing HIPEC due to preoperative fasting, epidural analgesia, accumulation of subcutaneous fluid, bleeding and insensible fluid loss. It is common practice to compensate perioperatively for the fasting status with 5–10 mL per kg body weight, and for the effect of the epidural analgesia with a 500-mL fluid bolus. Furthermore, during the operation fluid at 10 mL/kg/h is usually administered. This practice is not patient tailored. Urine output is an unreliable measure of fluid status during HIPEC due to administration of various medication, e.g., opiates, inotropic support, and diuretics (7). As a consequence, most patients undergoing HIPEC receive at least 7 L of intravenous fluids during the procedure (8)