Journal of surgical oncology
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Cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy have achieved good long-term results in patients with complete surgical eradication of their peritoneal dissemination but at the expense of significant perioperative morbidity and mortality. The high complication rate has been attributed to the steep learning curve associated with this procedure. We report on the current literature regarding the learning curve for this procedure and the key components that determine the success in learning this new skill.
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Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) provide a promising additional treatment option for selected patients with peritoneal carcinomatosis arising from colorectal cancer. Due to the aggressive surgery the concept is associated with a significant morbidity rate. Thus, the operative risk has to be evaluated against the background of the expected improvement of the oncological outcome.
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Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with high morbidity. The Quality of Life (QoL) assessment in this patient group with a limited life expectancy and high recurrence rate is important. Published data show an impairment of postoperative Quality of Life at 3 months postoperatively with an improvement over 6-12 months at levels higher than the baseline. Standardized instruments QoL have to be included in clinical trials assessing the efficacy of CRS and HIPEC.
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Review
Perioperative management of patients with cytoreductive surgery for peritoneal carcinomatosis.
Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) has become an important tool in the management of patients with peritoneal malignancies. It is a complex surgical procedure with significant fluid loss during debulking leading to relevant pathophysiological alterations and therefore a challenge for anesthesiologists and critical care physicians. This review summarizes perioperative changes in hemodynamics, oxygen supply, coagulation, hematopoetic parameters and fluid status during cytoreductive surgery and HIPEC and how to deal with these pathophysiological alterations.
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Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy has provided unprecedented results in the management of peritoneal-based neoplasms. Prognostic factors leading to a survival advantage when this treatment modality is employed have been identified. A steep learning curve has been described as well. Therefore, knowledgeable indication setting and proper selection of patients to whom this combined treatment can be offered is warranted in order to obtain the best results at the lowest possible toxicity.