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Online ISSN 1827-1596
Federico COCCOLINI 1, Davide CORBELLA 2, Paolo FINAZZI 2, Pietro BRAMBILLASCA 2, Alberto BENIGNI 2, Viviana PRUSSIANI 2, Marco CERESOLI 1, Roberto MANFREDI 1, Elia POIASINA 1, Paolo BERTOLI 1, Fausto CATENA 3, Andrea BIANCHETTI 4, Mario BONTEMPELLI 4, Luca F. LORINI 2, Valter SONZOGNI 2, Luca ANSALONI 1
1 Department of General Surgery, “Papa Giovanni XXIII” Hospital, Bergamo, Italy; 2 Department of Anesthesiology, “Papa Giovanni XXIII” Hospital, Bergamo, Italy; 3 Department of Emergency Surgery, Maggiore Hospital, Parma, Italy; 4 Department of Laboratory Medicine, “Papa Giovanni XXIII” Hospital, Bergamo, Italy
BACKGROUND: Systemic response to cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) causes the activation of endocrine, metabolic, hemodynamic and inflammatory processes. The aim of this work is to describe and analyze the time course of the inflammatory markers concentration during CRS+HIPEC in plasma and peritoneal fluids and the association with hemodynamic and metabolic parameters.
METHODS: Pre-, intra- and postoperative data were collected. Tumor necrosis factor (TNF), interleukine 6 (IL-6), pro-calcitonin (PCT), cancer antigen 125 (CA-125) in blood and in peritoneal fluids were evaluated.
RESULTS: Thirty-eight patients were included, 29 (76.3%) of them were female. Mean/median PCI was 9.2/5, primary malignancy was 5 colorectal cancer (13.2%), 5 gastric cancer (13.2%), 23 ovarian cancer (60.5%) and 5 other malignancies (13.2%). Combined clinical risk 0-1 was reached in all patients. Cardiac index, heart rate and central venous pressure increased during the procedure, while stroke volume variation showed a decrease. Mean arterial pressure and superior vena cava oxygenation were stable throughout the whole procedure. TNF and CA-125 were steady during the whole procedure; IL-6 had a relevant increase from baseline to start of perfusion (P<0.01); PCT had a steady increase at every time point. Peritoneal sampling showed a statistically significant increase (P<0.01) between start and end of the perfusion phase for all markers but TNF. Serum and peritoneal marker concentration were similar for TNF, PCT and CA-125. IL-6 showed a sharp difference.
CONCLUSIONS: The most significant variations were in IL-6 and PCT levels. The cytokines level parallels the hemodynamic derangements. Treatment during HIPEC should mimic the established treatment during sepsis and septic shock.