Perioperative management of the oncologic patient undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC)

The standard surgical treatment option for peritoneal carcinomatosis (PC) is cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). This is an aggressive and complex treatment that often involves multi-visceral resection including extensive peritonectomies, splenectomy, bowel resections, and removal of other major organs that are involved with tumor. Upon completion of surgical extirpation of tumor, heated chemotherapy is instilled into the peritoneal cavity, and the abdomen is agitated for 60-120 min. The extensive nature of these procedures is associated with longer and more complicated anesthetic administration. There are many challenges for the anesthetic team related to blood loss, temperature shifts, extensive fluid loss, and toxicity related to chemotherapy. A basic knowledge of chemotherapy drugs that are used during the HIPEC phase is also needed. A thorough understanding of this multimodal treatment is necessary to keep the patients safe during all phases of perioperative care.