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Anaesthesia and intensive care during intraoperative intraperitoneal hyperthermic chemotherapy in patients with gastric cancer (literature review and own clinical experience)


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Abstract

Despite a steady decline in the incidence in recent decades, gastric cancer remains one of the most frequent causes of death from cancer in the world. By the time of diagnosis the tumor process is locally advanced or generalized in nearly 70% of patients that reduces the possibility of radical surgical treatment. Peritoneal carcinomatosis is a one of the main causes of treatment failure. There patients need complex treatment with cytoreductive surgery and intraoperative hyperthermic intraperitoneal chemotherapy (IHIC) to improve the quality and duration of life. Today in Russia, surgeries with IHIC are performed in a very limited number of oncology hospitals, thus there is no unified approach to the perioperative management of these patients. Design: Since November 2010 in our institution we started a prospective clinical study of the use of intraoperative hyperthermic intraperitoneal chemotherapy in patients with locally advanced or metastatic gastric cancer. Materials and Methods: The study included 30 patients (18 men and 12 women) who underwent transabdominal gastrectomy with extended lymphadenectomy D2, supplemented principled cholecystectomy and oophorectomy (in women). Mean age was 48.5 ± 5.3 years. Technique involved the use of regional anesthesia component and inhalation anesthetic sevoflurane. Preoperative preparation included enteral nutrition (based on 25-30 kcal / kg / day), liver protection (intravenous remaxol infusion of 500 ml / day for 3 days prior to surgery), antisecretory and antifermental therapy (omeprazole 40 mg / day, 100 mg octreotide for 2 h before surgery, aprotinin sulfate 30000 after induction of anesthesia), antioxidant and immunomodulatory therapy (galavit, cytoflavin, ceruloplasmin vitamin C), anticoagulant prophylaxis (enoxaparin sodium 40 mg on the evening before surgery). Results: Analysis of the world and our own clinical experience with intraoperative hyperthermic intraperitoneal chemotherapy in a comprehensive plan of treatment of patients with gastric cancer showed that the this aggressive, but highly effective technique can be requires not only careful patient selection according to the criteria, but also the use of special methods to protective therapy at all stages of the surgical treatment. Application ofpathogenetic ways ofprotection from thermal injury, timely control and correction of homeostasis caused by the toxic effects of chemotherapy and burn peritoneum, early enteral nutrition and the use of organ-therapy reduce the risk of complications and achieve better results of treatment in cancer patients.


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