Anaesthetic management for combined cytoreductive surgery, hyperthermic intraperitoneal chemotherapy (HIPEC), and hyperthermic intrathoracic chemotherapy (HITHOC) in a patient with advanced ovarian carcinoma and pleural metastases: A case report

Background: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is established for peritoneal metastases, but managing pleural metastases remains challenging. Hyperthermic intrathoracic chemotherapy (HITHOC) is an emerging modality. The combined procedure (CRS+HIPEC+HITHOC) presents profound anaesthetic challenges. We report the successful anaesthetic management of a patient undergoing this combined procedure.Case Presentation: A 51-year-old female with advanced ovarian carcinoma and biopsy-proven pleural metastases underwent complete CRS followed by HIPEC (cisplatin, 43°C, 90 min) and right-sided HITHOC (cisplatin/doxorubicin, 60 min) in a single sitting. Anaesthetic management included invasive hemodynamic monitoring, dual epidural catheters, goal-directed fluid therapy, and aggressive electrolyte correction. Sodium thiosulfate was used for nephroprotection. Key challenges included managing hemodynamic instability during HITHOC, temperature fluctuations, and chemotherapy-related toxicity.Conclusion: The combination of CRS, HIPEC, and HITHOC is a high-risk procedure necessitating a meticulous, multidisciplinary approach. Vigilant anaesthetic management focusing on advanced monitoring, precise fluid and vasopressor titration, temperature control, and organ protection is crucial for patient safety and positive outcomes. This case demonstrates that with expert management, such complex procedures can be performed successfully, offering a potential therapeutic option for selected patients.