Particularities of anesthesia and postoperative intensive care related to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Introduction Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy improves the prognosis of selected patients, in particular those with appendiceal and colon carcinoma (1). At least one third of all patients is still alive after treatment. Main prognostic factors are completeness of cytoreduction and the tumor volume expressed by the Peritoneal Cancer Index (should be lower than 20 for colorectal malignancies)(2). This is a combined numerical score of lesion size (LS-0 to LS-3) and tumor localization (region 0-12)(3). Gastric cancer is different, mainly because of the aggressive tumor biology. The natural history is limited to few months and even with most modern, best available systemic treatment chemotherapies, the median survival is limited (4). Other indications are: gastric cancer with peritoneal carcinomatosis, recurrent ovarian cancer with peritoneal carcinomatosis and malignant peritoneal mesothelioma. Cytoreductive surgery consists in these patients of so-called parietal and visceral peritonectomy procedures (5). Affected areas of the peritoneal surface have to be removed, often by multivisceral resections. Surgery may include parietal and visceral peritonectomy, greater omentectomy, splenec-