Thong Sze Ying, Chia Claramae Shulyn, Ng Oriana, Tan Grace, Ong Ee Teng, Soo Khee Chee, Teo Melissa
Department of Anaesthesia, Singapore General Hospital, Singapore.
Division of Surgical Oncology, National Cancer Centre Singapore, Singapore.
Singapore Med J. 2017 Aug;58(8):488-496. doi: 10.11622/smedj.2016078. Epub 2016 Apr 28.
Cytoreductive surgery (CRS) along with hyperthermic intraperitoneal chemotherapy (HIPEC) is the treatment of choice for selected patients with peritoneal carcinomatosis, a previously lethal condition with dismal survival rates.
We reviewed CRS and HIPEC procedures performed at our centre from January 1997 to December 2012, focusing on perioperative events and anaesthetic implications.
In total, 111 patients underwent 113 procedures. Mean age of the patients was 51.7 (range 14-74) years and 84.1% were women. Mean duration of surgery was 9 hours 10 minutes ± 2 hours 56 minutes. Most tumours were ovarian or colorectal in origin, and the mean peritoneal cancer index (PCI) score was 14.3 ± 8.9. Mean estimated blood loss was 1,481 ± 1,064 mL. Mean total intravenous fluids and blood products administered was 8,498 ± 3,941 mL. Postoperatively, 79.5% of the patients needed intensive care, as 75.2% of the 113 procedures required interval extubation. Patients with lower PCI scores were more likely to be extubated immediately after surgery (p < 0.05). 80.0% of patients had coagulopathy postoperatively, and this was associated with longer HIPEC duration (p < 0.05). Median lengths of intensive care unit and hospital stays were two days and 14 days, respectively. Longer duration of surgery significantly correlated with longer hospitalisation. Prolonged hospitalisation was due to nosocomial pneumonia, pleural effusions, respiratory failure, sepsis, surgical complications (such as anastomotic or wound dehiscence), and intra-abdominal infections.
The CRS and HIPEC technique is a major surgery with significant morbidity, as highlighted by the perioperative concerns observed in our study.
细胞减灭术（CRS）联合腹腔热灌注化疗（HIPEC）是部分腹膜癌患者的首选治疗方法，腹膜癌曾是一种致命疾病，生存率极低。
我们回顾了1997年1月至2012年12月在本中心进行的CRS和HIPEC手术，重点关注围手术期事件及麻醉影响。
共有111例患者接受了113例手术。患者的平均年龄为51.7岁（范围14 - 74岁），84.1%为女性。平均手术时长为9小时10分钟±2小时56分钟。大多数肿瘤起源于卵巢或结肠直肠，平均腹膜癌指数（PCI）评分为14.3±8.9。平均估计失血量为1481±1064毫升。平均输注的总静脉液体和血液制品量为8498±3941毫升。术后，79.5%的患者需要重症监护，因为113例手术中有75.2%需要间断拔管。PCI评分较低的患者术后更有可能立即拔管（p<0.05）。80.0%的患者术后出现凝血功能障碍，这与HIPEC持续时间较长有关（p<0.05）。重症监护病房和住院的中位时长分别为两天和14天。手术时间较长与住院时间延长显著相关。住院时间延长的原因包括医院获得性肺炎、胸腔积液、呼吸衰竭、败血症、手术并发症（如吻合口或伤口裂开）以及腹腔内感染。
正如我们研究中观察到的围手术期问题所强调的，CRS和HIPEC技术是一种具有显著发病率的大手术。
