a Department of Anesthesiology and Perioperative Medicine , The University of Texas MD Anderson Cancer Center , Houston , TX , USA.
b Department of Surgical Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA.
Int J Hyperthermia. 2019;36(1):493-498. doi: 10.1080/02656736.2019.1597175. Epub 2019 Apr 1.
Laparoscopic hyperthermic intraperitoneal chemotherapy (HIPEC) has been used to treat various peritoneal malignancies. Cisplatin and mitomycin C (MMC) are agents commonly used in these procedures and, individually, each has been associated with acute kidney injury (AKI). There is limited literature on the complications associated with the use of both agents in HIPEC. Therefore, we sought to determine the incidence of nephrotoxicity and electrolyte abnormalities in patients undergoing laparoscopic HIPEC using this chemotherapeutic combination.
We retrospectively evaluated patients undergoing laparoscopic HIPEC for gastric or gastroesophageal adenocarcinoma using both cisplatin and MMC. Sodium thiosulfate was given for renal protection and kidney function was evaluated daily up to postoperative day #2. Details regarding patient characteristics, selection criteria, chemotherapeutic regimen, perioperative lab values and anesthetic management were collected.
Twenty-three patients underwent 31 laparoscopic HIPEC procedures. Fifteen (65%) were male and the median age was 57 (range 21-75). Thirteen procedures were associated with an elevation in creatinine (Cr) with the median difference between POD#2 and baseline being 0.09 mg/dL (range 0-0.43). The glomerular filtration rate median difference between POD#2 and baseline was -17 mL/min/1.37 sq. m (range -42 to 11). No cases demonstrated AKI, defined as a 50% increase in Cr levels above baseline. An 84% incidence of postoperative hypophosphatemia (26/31) and 94% incidence of postoperative hypocalcemia (29/31) was observed.
The laparoscopic approach to HIPEC using both cisplatin and MMC in our cohort was not associated with an increased incidence of AKI. The incidence of hypophosphatemia and hypocalcemia needs further evaluation to determine the exact etiology. Precis' statement: We retrospectively studied the association of AKI with the combined use of cisplatin and MMC in laparoscopic HIPEC.
腹腔镜高温腹腔内化疗（HIPEC）已被用于治疗各种腹膜恶性肿瘤。顺铂和丝裂霉素 C（MMC）是这些手术中常用的药物，单独使用时，每种药物都与急性肾损伤（AKI）有关。关于 HIPEC 中使用这两种药物相关并发症的文献有限。因此，我们试图确定使用这种化疗组合行腹腔镜 HIPEC 的患者发生肾毒性和电解质异常的发生率。
我们回顾性评估了接受顺铂和 MMC 联合治疗的胃或胃食管腺癌行腹腔镜 HIPEC 的患者。使用硫代硫酸钠进行肾保护，每天评估肾功能，直到术后第 2 天。收集患者特征、选择标准、化疗方案、围手术期实验室值和麻醉管理等详细信息。
23 例患者共进行了 31 例腹腔镜 HIPEC 手术。15 例（65%）为男性，中位年龄为 57 岁（范围 21-75 岁）。13 例手术时肌酐（Cr）升高，术后第 2 天与基线相比，Cr 中位数差值为 0.09mg/dL（范围 0-0.43）。术后第 2 天与基线相比，肾小球滤过率中位数差值为-17mL/min/1.37m2（范围-42 至 11）。无病例出现 AKI，定义为 Cr 水平较基线升高 50%。术后低磷血症（26/31，84%）和低钙血症（29/31，94%）的发生率较高。
在我们的队列中，使用顺铂和 MMC 的腹腔镜 HIPEC 方法并未增加 AKI 的发生率。低磷血症和低钙血症的发生率需要进一步评估以确定确切的病因。
