Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. May 4, 2017; 6(2): 116-123
Published online May 4, 2017. doi: 10.5492/wjccm.v6.i2.116
Critical care management and intensive care unit outcomes following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy
Sumit Kapoor, Adel Bassily-Marcus, Rafael Alba Yunen, Parissa Tabrizian, Sabrine Semoin, Joseph Blankush, Daniel Labow, John Oropello, Anthony Manasia, Roopa Kohli-Seth
Sumit Kapoor, Department of Pulmonary, Critical Care and Sleep, Baylor College of Medicine, Houston, TX 77030, United States
Adel Bassily-Marcus, John Oropello, Anthony Manasia, Roopa Kohli-Seth, Department of Surgery, Critical Care Division, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
Rafael Alba Yunen, Department of Pulmonary and Critical Care, Medical College of Georgia, Augusta University, Augusta, GA 30912, United States
Parissa Tabrizian, Sabrine Semoin, Daniel Labow, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
Joseph Blankush, General Surgery Resident, Vanderbilt University Medical Center, Nashville, TN 37232, United States
Author contributions: Kapoor S and Bassily-Marcus A designed and performed the research and wrote the paper; Alba Yunen R, Tabrizian P and Semoin S contributed to data collection and analysis; Blankush J, Labow D, Oropello J, Manasia A and Kohli-Seth R provided clinical advice; Bassily-Marcus A supervised the report.
Institutional review board statement: This study was reviewed and approved by the Institutional review board of the Icahn School of Medicine at Mount Sinai, New York.
Informed consent statement: Patients were not required to give informed consent to the study because the retrospective analysis used anonymous clinical data that were ob-tained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Adel Bassily-Marcus, MD, FCCM, FCCP, FACP, Associate Professor, Department of Surgery, Critical Care Division, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, New York, NY 10029, United States. adel.bassily-marcus@mountsinai.org
Telephone: +1-212-2418867 Fax: +1-212-8603669
Received: November 11, 2016
Peer-review started: November 13, 2016
First decision: December 1, 2016
Revised: December 18, 2016
Accepted: January 11, 2017
Article in press: January 13, 2017
Published online: May 4, 2017
Processing time: 172 Days and 14.4 Hours
Abstract
AIM

To study the early postoperative intensive care unit (ICU) management and complications in the first 2 wk of patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

METHODS

Our study is a retrospective, observational study performed at Icahn School of Medicine at Mount Sinai, quaternary care hospital in New York City. All adult patients who underwent CRS and HIPEC between January 1, 2007 and December 31, 2012 and admitted to ICU postoperatively were studied. Fifty-one patients came to the ICU postoperatively out of 170 who underwent CRS and HIPEC therapy during the study period. Data analysis was performed using descriptive statistics.

RESULTS

Of the 170 patients who underwent CRS and HIPEC therapy, 51 (30%) came to the ICU postoperatively. Mean ICU length of stay was 4 d (range 1-60 d) and mean APACHE II score was 15 (range 7-23). Thirty-one/fifty-one (62%) patients developed postoperative complications. Aggressive intraoperative and postoperative fluid resuscitation is required in most patients. Hypovolemia was seen in all patients and median amount of fluids required in the first 48 h was 6 L (range 1-14 L). Thirteen patients (25%) developed postoperative hypotension with seven requiring vasopressor support. The major cause of sepsis was intraabdominal, with 8 (15%) developing anastomotic leaks and 5 (10%) developing intraabdominal abscess. The median survival was 14 mo with 30 d mortality of 4% (2/51) and 90 d mortality of 16% (8/51). One year survival was 56.4% (28/51). Preoperative medical co morbidities, extent of surgical debulking, intraoperative blood losses, amount of intra op blood products required and total operative time are the factors to be considered while deciding ICU vs non ICU admission.

CONCLUSION

Overall, ICU outcomes of this study population are excellent. Triage of these patients should consider preoperative and intraoperative factors. Intensivists should be vigilant to aggressive postop fluid resuscitation, pain control and early detection and management of surgical complications.

Keywords: Hyperthermic; Abdominal sepsis; Cytoreduction; Carcinomatosis; Respiratory failure; Vasopressors

Core tip: Our retrospective study highlights the intensive care unit (ICU) management, complications and outcomes of patients undergoing complicated hyperthermic intraperitoneal chemotherapy procedure for peritoneal carcinomatosis. Intensivists need to monitor for physiologic derangements post procedure and assess fluid status, provide adequate pain control and have high degree of suspicion for complications like abdominal sepsis. Not all patients need ICU admission post procedure. Our study enlists the factors to be considered for ICU admission vs the floor.