Anesthesia and Pain Management for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Desmoplastic Small Round Cell Tumors in Children, Adolescents, and Young Adults

Desmoplastic small round cell tumor (DSRCT) is a rare, aggressive sarcoma. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) may improve survival.

A retrospective review of anesthetic management and postoperative pain control strategies after CRS/HIPEC for DSRCT from 2013 to 2017 was performed.

The review analyzed 10 CRS/HIPEC procedures performed for nine DSRCT patients with a median age of 19 years (range 10–24 years). Six of these patients were Caucasian, and seven were men. The median operative duration was 551 min (range 510–725 min), and the median anesthesia duration was 621 min (range 480–820 min). Postoperative mechanical ventilation was necessary in 5 patients for a median duration of 1 day (range 0–2 days). The median intraoperative intravenous fluid administration was 13 ml/kg/h (range 6.3–24.4 ml/kg/h), and the colloid administration was 12 ml/kg (range 0.0–53.0 ml/kg). The median blood loss was 15 ml/kg (range 6.3–77.2 ml/kg). Nine patients received intraoperative transfusion with a median red blood cell transfusion volume of 14 ml/kg (range 10.1–58.5 ml/kg). The median intraoperative urine output was 2 ml/kg/h (range 0.09–8.40 ml/kg/h), and half of the patients received intraoperative diuretics. Cisplatin was used during HIPEC for eight surgeries. Acute kidney injury was observed in two patients, one of whom required short-term dialysis. Epidural infusions were used in eight cases for a median of 4 days (range 3–5 days). Postoperative intravenous opioid use (morphine equivalent) was 0.67 mg/kg/day (range 0.1–9.2 mg/kg/day) administered for a median of 11 days (range 2–35 days).

Cytoreduction and HIPEC for DSRCT are associated with significant perioperative fluid requirements and potentially challenging pain management. Renal protective strategies should be considered for reduction of cisplatin-associated nephrotoxicity. Further investigation for a more effective, less systemically toxic HIPEC agent is warranted.