Article Text
PDF
Abstract
Introduction/Background Cytoreductive surgery (CRS) associated with hyperthermic intraperitoneal chemotherapy (HIPEC) is an essential treatment for peritoneal carcinomatosis (PC). Cisplatin is known to cause acute renal failure (ARF) after systemic or intraperitoneal administration. After accumulation, it can lead to nephrotoxicity in one-third of intravenous prescriptions and up to 40% of ARF for the IP route, with progressive and irreversible chronic renal failure. In addition to preoperative hyperhydration, sodium thiosulfate (ST) is a well-known pharmaceutical agent and has been used in the prevention of Cisplatin-induced toxicity, particularly renal toxicity. The objective of our study was to evaluate the interest in preoperative intravenous hydration alone or in combination with ST to prevent nephrotoxicity induced during intraperitoneal Cisplatin in patients who underwent CRS with HIPEC.
Methodology Retrospective single-tertiary-center analysis of all consecutive patients treated by CRS with Cisplatin-based HIPEC between January 01, 2015, and July 30, 2020. All types of PC were included. There were three consecutive periods of study corresponding to 3 different treatments. A first group was treated with preoperative hyperhydration alone (group 1 – PHH), a second one with preoperative hyperhydration (3L/24 h of Ringer-Lactate) with the addition of ST (group 2 – PHH + ST), and a third one with ST alone (group 3 – ST).
Results Period study included 230 consecutive patients underwent. Median age was 59 years (interquartile range 49 – 68 years), with 76% women. Higher rate of complete cytoreduction (CC0) were achieved in PHH + ST and ST alone (92% and 97%, respectively, vs 77%, p < 0.001). PHH + ST and ST alone had better postoperative renal function without acute injury compared to group 1 (p<0.001).
Conclusion In addition to the nephroprotective benefit, ST also appears to be associated with better cytoreduction results. Hyperhydration does not provide any additional benefit.