La chimiothérapie hyperthermique intra-péritonéale (CHIP) (podcast)

Hyperthermic intraperitoneal chemotherapy (HIPEC) was first described in the early 1990s. This procedure is used in the treatment of peritoneal carcinomatosis (colorectal cancers, primitive diseases of the peritoneum) with an expected survival time less than 6 months. It combines a complete cytoreductive surgical procedure with both systemic and intra-peritoneal chemotherapy. It is associated with a high morbidity and mortality. Patient's selection is paramount to keep a reasonable risk/benefit ratio. HIPEC requires a good coordination between surgical teams, anesthesiologist and intensivists familiar with the management of these patients. During intra-operative phase, the anesthetic management aims primarily maintaining fluid and electrolyte balance, reducing hemodynamic and temperature changes throughout surgery which can last more than 10 hours. Surgical (hemoperitoneum, peritonitis, fistula) or medical (hematologic toxicity, pulmonary embolism, sepsis, pneumonia) complications may occur. The median survival time of patients increased from 6 months to 22 to 63 months with HIPEC. After a convalescence phase of approximately 3 months, the patients' quality of life is usually good.