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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2018

01-03-2018 | Colorectal Cancer

Implications of Hyperthermic Intraperitoneal Chemotherapy Perfusion-Related Hyperglycemia

Authors: Camille L. Stewart, MD, Ana Gleisner, MD, Alison Halpern, MD, Irada Ibrahim-Zada, MD, Rodrigo Asturias Luna, MD, Nathan Pearlman, MD, Csaba Gajdos, MD, Barish Edil, MD, Martin McCarter, MD

Published in: Annals of Surgical Oncology | Issue 3/2018

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Abstract

Background

Hyperthermic intraperitoneal chemotherapy (HIPEC) administration can be associated with hyperglycemia during perfusion. Little is known about this effect, and no previous studies have examined patient characteristics associated with perfusion-related hyperglycemia.

Methods

We retrospectively identified consecutive patients at a single institution treated with HIPEC from 8/2003 to 10/2016 who had intraoperative blood glucose measured. Hypertonic 1.5% dextrose-containing peritoneal dialysate was used as carrier solution in all patients. Comparisons were made using parametric [Student’s t test, analysis of variance (ANOVA)], and nonparametric tests (χ 2, Kruskal–Wallis) where appropriate.

Results

There were 85 patients identified, with average age of 53 ± 12 years, 69 (81%) with appendiceal or colorectal peritoneal cancer. Most patients were perfused with mitomycin C (69%) or oxaliplatin (24%). Intraoperative hyperglycemia (> 180 mg/dL) affected the majority of patients (86%), with values up to 651 mg/dL. Insulin was required for treatment in 66% of patients. Peak hyperglycemia occurred within an hour of perfusion in 91%, and resolved by postoperative day one in 91% of patients. Glucose > 309 mg/dL (highest quartile) was associated with longer operating time (p = 0.03) and with use of oxaliplatin compared with mitomycin C (p = 0.01). No association was found with other comorbidities, peritoneal carcinomatosis index score, or postoperative outcomes.

Conclusions

Most patients experience hyperglycemia during HIPEC. This is not clearly associated with patient factors, and may be due to use of dextrose-containing carrier solution. Since perioperative hyperglycemia has potential negative impact, use of dextrose-containing carrier solution should be questioned and is worth investigating further.
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Metadata
Title
Implications of Hyperthermic Intraperitoneal Chemotherapy Perfusion-Related Hyperglycemia
Authors
Camille L. Stewart, MD
Ana Gleisner, MD
Alison Halpern, MD
Irada Ibrahim-Zada, MD
Rodrigo Asturias Luna, MD
Nathan Pearlman, MD
Csaba Gajdos, MD
Barish Edil, MD
Martin McCarter, MD
Publication date
01-03-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 3/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-017-6284-6

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