Perioperative management of patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a state of the art

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is considered the standard of care for the treatment of primary and secondary peritoneal malignancies. Based on the combination of intravenous and hyperthermic intraperitoneal chemotherapy following surgical removal of the macroscopic tumor, CRS with HIPEC is associated with increased survival and reduced five-year mortality. However, CRS with HIPEC induces pathophysiological changes that require rigorous intraoperative management. Thus, CRS with HIPEC remains a challenge for anesthesiologists in the preoperative (e.g. patients selection, prehabilitation), perioperative (e.g. hemodynamic monitoring, ventilation) and postoperative periods. Unfortunately, there are few recent articles discussing intraoperative aspects and guidelines based on a standardized expert consensus process. Based on the most recent studies and expert consensus available on the subject, this review summarizes the challenges faced by anesthesiologists and intensivists regarding the pathophysiology and changes induced by CRS in HIPEC during the perioperative period.