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Elevated brain natriuretic peptide (BNP) is an early marker for patients at risk for complications after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC).
- Source :
-
Journal of surgical oncology [J Surg Oncol] 2018 Mar; Vol. 117 (4), pp. 685-691. Date of Electronic Publication: 2017 Nov 28. - Publication Year :
- 2018
-
Abstract
- Background: Elevated BNP is associated with adverse cardiac outcomes after noncardiac surgery. We assessed BNP values as markers of perioperative fluid status and their correlation with major/cardiopulmonary (CP) complications following CRS + HIPEC.<br />Methods: Fluid balance, BNP levels, and morbidity data were collected for all patients undergoing CRS + HIPEC between 6/2014 and 2/2016.<br />Results: One hundred and twenty-nine patients underwent CRS + HIPEC for appendiceal adenocarcinoma (n = 99), mesothelioma (n = 16), and colon cancer (n = 14). Less than 10% had CP comorbidities. The median PCI was 14 (range 4-39); 89% underwent CC0/1 resection (n = 115). Median blood loss (EBL) was 497 mL (50-2700). Major complications (Clavien III-V) occurred in 16 (12%), CP in 17 (13%), and major/CP in 24 (18%). Thirty-day mortality occurred in 2 (1.5%). Elevated BNP on POD1 correlated with increased risk of major/CP complications (OR 2.2, P = 0.052). This was most pronounced in the 25 patients receiving cisplatin: for each 100 unit increase in POD1 BNP the OR for major/CP complication was 7.4 versus 1.2 for the remaining patients, P = 0.083. Multivariate analysis identified increased EBL (OR 4.1 P = 0.011) and a trend toward increased BNP on POD1 (OR for each 100 unit increase 2.0, P = 0.10) as risk factors for major/CP complications.<br />Conclusions: Postoperative BNP measurement after CRS + HIPEC may guide postoperative fluid resuscitation and facilitate identification of patients at risk for major and/or cardiopulmonary complications.<br /> (© 2017 Wiley Periodicals, Inc.)
- Subjects :
- Adenocarcinoma drug therapy
Adenocarcinoma metabolism
Adenocarcinoma surgery
Adenocarcinoma therapy
Adult
Aged
Appendiceal Neoplasms drug therapy
Appendiceal Neoplasms metabolism
Appendiceal Neoplasms surgery
Appendiceal Neoplasms therapy
Brain metabolism
Colonic Neoplasms drug therapy
Colonic Neoplasms metabolism
Colonic Neoplasms surgery
Colonic Neoplasms therapy
Combined Modality Therapy
Cytoreduction Surgical Procedures adverse effects
Cytoreduction Surgical Procedures methods
Female
Humans
Hyperthermia, Induced adverse effects
Hyperthermia, Induced methods
Lung Neoplasms drug therapy
Lung Neoplasms metabolism
Lung Neoplasms surgery
Lung Neoplasms therapy
Male
Mesothelioma drug therapy
Mesothelioma metabolism
Mesothelioma surgery
Mesothelioma therapy
Mesothelioma, Malignant
Middle Aged
Neoplasms drug therapy
Neoplasms surgery
Predictive Value of Tests
Retrospective Studies
Young Adult
Natriuretic Peptide, Brain metabolism
Neoplasms metabolism
Neoplasms therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1096-9098
- Volume :
- 117
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Journal of surgical oncology
- Publication Type :
- Academic Journal
- Accession number :
- 29193085
- Full Text :
- https://doi.org/10.1002/jso.24904