Staged HIPEC may be feasible when it is not possible along with the same setting of CRS

Abstract

Introduction: Hyperthermic intraperitoneal chemotherapy (HIPEC) is a well-known procedure for peritoneal surface malignancies. Usually, the procedureis supposed to be performed in the same setting after completion of optimal cytoreductive surgery (CRS). Due to some intraoperative issues, we performedHIPEC in early postoperative period or else around 30 days of index surgery. We call this protocol as “Staged HIPEC”.

Material & Methods: Fourteen patients were included from September 2017 to November 2019 from a prospectively maintained database. Patients in whomHIPEC procedure was deferred in the same sitting following optimal CRS, due to various reasons & it was performed either in the early postoperative period(1-3 days) or around 30 days (4 – 6 weeks) of index surgery, were included in this study. All the patients were followed up till 31st March 2020.

Results: During CRS twelve patients (85.7%) developed hypotension with oliguria and two patients (14.2%) developed tachyarrhythmia. Clavin Dindo grade II & grade III complication occurred in 7 patients (50%) & five patients (35.7%) respectively. No complication occurred due to Staged HIPEC. No perioperative mortality was observed in the current study. Average disease-free interval was 13.5 months (range 4-21 months).

Conclusion: As there were no significant complications occurred due to staged HIPEC and the disease-free interval was comparable to CRS & HIPEC procedure in the same setting, “staged HIPEC” may be a feasible option for those patients, who were hemodynamically unstable during CRS, and HIPEC procedure, was not possible at the same setting.