Anesthesia and Surgery for Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Cytoreductive surgery (CRS) was initially described in the 1930s for patients with locally advanced gynecological cancers to reduce the symptomatic burden. The addition of hyperthermic intraperitoneal chemotherapy (HIPEC) was reported in 1955 for patients with ovarian cancer and was found to offer a survival benefit in trials conducted in the 1980s. The use of CRS with HIPEC is increasing and is used to treat patients with peritoneal spread of multiple primary carcinomas, such as appendiceal, colorectal, ovarian, and mesothelioma. Anesthesia in these patients can present with complex issues throughout the perioperative period. Preoperative assessment presents an opportunity to thoroughly assess patients and optimize their physical status prior to surgery through prehabilitation, nutritional, pharmacological, and psychological interventions. Intraoperative management involves careful attention to fluid management, as fluid shifts are common. Appropriate analgesia is required, and patients usually require neuraxial analgesia for both intra- and postoperative management. Management of both hypo- and hyperthermia is also a key consideration during surgery, as temperature swings can be common. Enhanced recovery protocols can be implemented to improve postoperative outcomes and reduce the length of hospital stay. Patients undergoing CRS and HIPEC procedures present unique surgical and anesthetic challenges. The overall survival of patients is improving, and increased attention to detail in the perioperative period will reduce complications and improve outcomes for these patients.