Fisher Sarah B, Rafeeq Safia, Hess Ken, Grotz Travis E, Mansfield Paul, Royal Richard, Badgwell Brian, Fleming Jason, Fournier Keith, Mann Gary N
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas.
J Surg Oncol. 2018 Mar;117(4):685-691. doi: 10.1002/jso.24904. Epub 2017 Nov 28.
Elevated BNP is associated with adverse cardiac outcomes after noncardiac surgery. We assessed BNP values as markers of perioperative fluid status and their correlation with major/cardiopulmonary (CP) complications following CRS + HIPEC.
Fluid balance, BNP levels, and morbidity data were collected for all patients undergoing CRS + HIPEC between 6/2014 and 2/2016.
One hundred and twenty-nine patients underwent CRS + HIPEC for appendiceal adenocarcinoma (n = 99), mesothelioma (n = 16), and colon cancer (n = 14). Less than 10% had CP comorbidities. The median PCI was 14 (range 4-39); 89% underwent CC0/1 resection (n = 115). Median blood loss (EBL) was 497 mL (50-2700). Major complications (Clavien III-V) occurred in 16 (12%), CP in 17 (13%), and major/CP in 24 (18%). Thirty-day mortality occurred in 2 (1.5%). Elevated BNP on POD1 correlated with increased risk of major/CP complications (OR 2.2, P = 0.052). This was most pronounced in the 25 patients receiving cisplatin: for each 100 unit increase in POD1 BNP the OR for major/CP complication was 7.4 versus 1.2 for the remaining patients, P = 0.083. Multivariate analysis identified increased EBL (OR 4.1 P = 0.011) and a trend toward increased BNP on POD1 (OR for each 100 unit increase 2.0, P = 0.10) as risk factors for major/CP complications.
Postoperative BNP measurement after CRS + HIPEC may guide postoperative fluid resuscitation and facilitate identification of patients at risk for major and/or cardiopulmonary complications.
非心脏手术后，脑钠肽（BNP）升高与不良心脏结局相关。我们评估了BNP值作为围手术期液体状态的标志物，及其与细胞减灭术联合腹腔热灌注化疗（CRS + HIPEC）后主要/心肺（CP）并发症的相关性。
收集了2014年6月至2016年2月期间所有接受CRS + HIPEC治疗的患者的液体平衡、BNP水平和发病率数据。
129例患者因阑尾腺癌（n = 99）、间皮瘤（n = 16）和结肠癌（n = 14）接受CRS + HIPEC治疗。CP合并症患者不到10%。中位腹膜癌指数（PCI）为14（范围4 - 39）；89%的患者接受CC0/1切除（n = 115）。中位失血量（EBL）为497 mL（50 - 2700）。主要并发症（Clavien III - V级）发生在16例（12%）患者中，CP并发症发生在17例（13%）患者中，主要/CP并发症发生在24例（18%）患者中。30天死亡率为2例（1.5%）。术后第1天（POD1）BNP升高与主要/CP并发症风险增加相关（比值比[OR] 2.2，P = 0.052）。这在25例接受顺铂治疗的患者中最为明显：POD1时BNP每升高100单位，主要/CP并发症的OR为7.4，而其余患者为1.2，P = 0.083。多因素分析确定，EBL增加（OR 4.1，P = 0.011）和POD1时BNP有升高趋势（每升高100单位的OR为2.0，P = 0.10）是主要/CP并发症的危险因素。
CRS + HIPEC术后测量BNP可能指导术后液体复苏，并有助于识别有发生主要和/或心肺并发症风险的患者。
