Perioperative considerations in the cancer patient undergoing cytoreductive surgery combined with heated intraperitoneal chemotherapy

Cytoreductive surgery (CCR) combined with (heated intraperitoneal chemotherapy [HIPEC]) improves the prognosis of selected patients with superficial peritoneal neoplasms. The first administration of intraperitoneal drugs dates from the eighteenth century. In 1995, Sugarbaker formally describes the technique of peritonectomy and demonstrates that the use of cytotoxic agents allows a more intensive treatment. The objetive of CCR is to obtain a complete macroscopic cytoreduction (RCC-0/1) of peritoneal disease and that of HIPEC is to remove the non-visible microscopic tumor or to treat small residual tumor deposits (<2.5 mm), with the purpose of prolonging the survival and favoring the quality of life of these patients. The drugs used are hydrophilic of high molecular weight and high concentrations that can not cross the peritoneal barrier to the plasma, resulting in a slow peritoneal clearance. This surgical technique represents a challenge for the anesthesiologist because of the different pathophysiological alterations that triggers this type of procedure. In addition, the National Institute of Cancerology carries out the enhaced recovery after surgery protocol for the rapid recovery of patients taking into account: antimicrobial prophylaxis, normotermia, normovolemia, normoglycemia, postoperative analgesy, and thromboprophylaxis, which are considered in this review.