Prise en charge périopératoire d'une chimiohyperthermie intrapéritonéale

Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is used in selected patients with peritoneal surface malignancy. Encouraging results document a survival benefit in selected patients with acceptable morbidity and mortality rates. Cytoreductive surgery combines peritonectomy procedures and complex organ resections aiming to eradicate all the macroscopic disease. The infusion of the abdominal cavity with heated chemotherapeutic agents at 42 °C, targets all microscopic residual disease. Monitoring includes haemodynamic status and renal function especially with nephrotoxic chemotherapy such as cisplatin. Electrolytic disorder depends on the intraperitoneal (IP) chemotherapy and the supporting solution (dextrose or saline). When IP chemotherapy is associated with dextrose, hyperglycemia has to be treated with insulin. In the absence of contraindication, epidural analgesia for at least 5 days should be favored. The treatment of pain and nutrition are essential elements of rehabilitation.