Perioperative approach to nephrotoxicity in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

doi:10.4240/wjgs.v17.i10.111885

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Oct 27, 2025 (publication date) through Nov 16, 2025

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Gastrointest Surg. Oct 27, 2025; 17(10): 111885
Published online Oct 27, 2025. doi: 10.4240/wjgs.v17.i10.111885

Perioperative approach to nephrotoxicity in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Şenay Göksu, Özgül Düzgün

Şenay Göksu, Department of Anesthesiology and Reanimation, University of Health Sciences, Ümraniye Training and Research Hospital, Istanbul 34764, Türkiye

Özgül Düzgün, Department of Surgical Oncology, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul 34764, Türkiye

Author contributions: Göksu Ş collected the patients’ clinical data, analyzed the data, and wrote the manuscript; Düzgün Ö contributed to the supervision of the project and to the preparation of the original draft. All authors read and approved the final version of the manuscript.

Institutional review board statement: The Ethics Committee of the University of Health Sciences, İstanbul Ümraniye Training and Research Hospital, approved the study, No. 2025-11.

Informed consent statement: Due to the retrospective nature of the study, informed consent was not obtained from the patients.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The data that supported the findings of this study are available from the corresponding author upon reasonable request.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Şenay Göksu, MD, Department of Anesthesiology and Reanimation, University of Health Sciences, Ümraniye Training and Research Hospital, Adem Yavuz Street, Istanbul 34764, Türkiye. goksust@gmail.com

Received: July 14, 2025
Revised: August 13, 2025
Accepted: September 26, 2025
Published online: October 27, 2025
Processing time: 104 Days and 22.8 Hours

Abstract

BACKGROUND

Combining cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a promising treatment approach for peritoneal carcinomatosis (PC). However, intraperitoneal chemotherapeutic agents significantly increase the risk of acute kidney injury (AKI). Identifying perioperative risk factors plays a critical role in preserving renal function.

AIM

To evaluate postoperative renal outcomes in patients with PC who underwent CRS + HIPEC.

METHODS

Patients who underwent CRS + HIPEC for PC between 2017 and 2024 were included in this retrospective cohort study. Demographic data, preoperative estimated glomerular filtration rate, HIPEC agents used (cisplatin, mitomycin C, oxaliplatin), intraoperative fluid management, vasopressor use, and postoperative creatinine levels were recorded. AKI was defined according to the 2012 Kidney Disease: Improving Global Outcomes criteria. Independent predictors were identified through multivariate logistic regression analysis.

RESULTS

AKI developed in 61 of 445 patients (13.7%). Among them, 62.0% were stage I, 24.6% were stage II, and 13.1% were stage III. The highest AKI rate was observed in the cisplatin group (21.4%), with lower rates in the oxaliplatin group (9.6%) and the mitomycin C group (6.5%). Independent risk factors included cisplatin use [odds ratio (OR) = 2.8; 95% confidence interval: 1.6-4.9; P < 0.001), intraoperative fluid administration < 6000 mL (OR = 2.1; P = 0.02), vasopressor requirement (OR = 1.9; P = 0.03), and preoperative estimated glomerular filtration rate < 75 mL/minute/1.73 m² (OR = 2.3; P = 0.01). AKI was associated with a prolonged hospital stay. Three patients (0.7%) progressed to chronic kidney disease.

CONCLUSION

Independent risk factors such as cisplatin use, inadequate fluid replacement, vasopressor requirement, and preoperative renal function should be considered during perioperative planning to reduce AKI risk following CRS + HIPEC.

Keywords: Cytoreductive surgery; Hyperthermic intraperitoneal chemotherapy; Acute kidney injury; Cisplatin; Estimated glomerular filtration rate; Perioperative management

Core Tip: We report an acute kidney injury incidence of 13.7% following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy treatment in patients with peritoneal carcinomatosis. Independent risk factors include cisplatin use, inadequate fluid replacement, vasopressor requirement, and reduced preoperative estimated glomerular filtration rate. The collective findings emphasized the importance of thorough preoperative renal function assessment and personalized perioperative fluid management. Chemotherapy agent selection plays a key role in minimizing renal toxicity. Optimal perioperative care is essential in preventing long-term renal complications.