Perioperative fast track program in intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery in advanced ovarian cancer
Summary (2 min read)
- Among factors related to morbidity and mortality, the learning curve is a crucial factor (30).
- Fast-track surgery is a comprehensive approach, designed to accelerate recovery, reduce morbidity and shorten convalescence to ultimately improve outcomes and reduce costs (32).
- Nephrectomy (42); radical prostatectomy (43); knee and hip prosthesis (44); abdominal aortic aneurysm (36); bariatric surgery (45,46) and lung resections (47) can all be carried out with a mean hospital admittance of less than 4 days and others such as antireflux surgery; suprarenalectomy; cholecystectomy; thyroidectomy; etc, are already carried out in many hospitals in ambulatory care (48,49).
- This study evaluated fast-track protocol in patients with advanced ovarian carcinoma who underwent peritonectomy procedures and HIPEC.
- A xiphopubic laparotomy was performed, evaluating the overall resectability of the peritoneal disease.
- Abdominal drainage was systematically left in the pelvis.
- The authors group uses a 60 miligrams/m² dose of the intraperitoneal cytostatic paclitaxel (32 patients) according with the excellent results reported previously by Rufian et al (19) and BAE et al (20).
- After cytoreduction the peritoneal cavity was positioned according to the “Coliseum” technique.
- Two intracavity thermometers monitored the temperature within the peritoneal cavity during perfusion, which was kept constant between 42-43 ºC.
- All patients received a low-residue diet one week before surgery and were admitted 1 day before surgery.
- After the intervention, a nasogastric tube was not used.
- Postoperative treatment included prokinetics (10-20 mgrs intravenous metoclopramide every 8 hours).
- MORBIDITY AND MORTALITY M AN US CR IP T AC CE PT ED ACCEPTED MANUSCRIPT Morbidity and mortality data were collected.
- Mild complications required medical or no treatment for resolution (grade I/II respectively).
- Forty-six patients (80.7%) were enrolled and 11 patients were excluded from the protocol, (6 because they required at least 2 digestive anastomoses and 5 because they could not carry out optimal surgery for their peritoneal disease).
- Right diaphragmatic peritonectomy (8 patients), splenectomy (2 patients), ureter resection (1 patient) and left diaphragmatic peritonectomy (1 patient) were needed to achieve complete cytoreduction.
- Paralytic ileus (6 patients) was the most common complication.
- The publication of the study by Kehlet in Lancet (33) has raised controversy about the classical attitude toward the postoperative management of surgically treated patients.
- Some authors opt for the non-use of abdominal drainage after surgery.
- The need for positioning the nasogastric tube due to vomiting when introducing orally administered food has been calculated to occur in at least 10% of cases (in their series 2 out of the 46 patients).
- This is one of the points the surgeon has to inform the patient about in the preoperative visit, given that otherwise the speed of events could be shocking.
- The authors preliminary data support the idea that in surgery for peritoneal carcinomatosis of ovarian origin with cytoreduction followed by HIPEC, the introduction of multimodal rehabilitation is reasonable in a group of selected patients with a low volume of carcinomatosis.
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Q1. What are the contributions mentioned in the paper "Perioperative fast track program in intraoperative hyperthermic intraperitoneal chemotherapy (hipec) after cytoreductive surgery in advanced ovarian cancer" ?
In this paper, the authors report on their experience in the treatment of advanced ovarian cancer using peritonectomy procedures and HIPEC through the fast track program.