Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: main concepts for anesthetists

Introduction: Hyperthermic intraperitoneal chemotherapy (HIPEC) is a complex therapeutic procedure used to complement cytoreductive surgery and intravenous chemotherapy for the management of primary peritoneal neoplasms and peritoneal carcinomatosis. Objectives: To review considerations regarding the surgical procedure, physiological changes associated with fluid, blood and protein loss, increase in intra-abdominal pressure, metabolic rate, and systemic hyperthermia, from the perspective of the anesthetist. Methods: A nonsystematic search was conducted in the Medline/PUBMED and Google Academics databases using the terms cytoreductive surgery, hyperthermia, HIPEC, peritoneal carcinomatosis, and Sugarbaker. No limits for publication dates were used. The articles were reviewed independently by each of the authors, and the final text was edited and approved by the main author. Results: Overall, 151 articles were identified, and, of these, 64 were included in the review. The aspects studied included the surgical technique, physiological changes during the procedure, and anesthetic management. Conclusion: Cytoreductive surgery with hyperthermic intra-peritoneal chemotherapy is a therapeutic option for patients with peritoneal carcinomatosis. This procedure involves risks for the patient, first because of an initial phase which involves fluid and blood loss, and, second, because the hyperthermic phase gives rise to a hyperdynamic state with hemodynamic instability. Anesthetists must be familiar with the basic aspects of management to reduce complications and improve patient outcomes.