Management of Complications of CRS and HIPEC

The potential clinical benefits of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have for long been overshadowed by its relatively high morbidity and mortality compared to other surgical procedures. It takes 3–12 months on an average for the quality of life to return to normal. With standardization of indications, better patient selection, development and implementation of perioperative care pathways and institution of formal teaching programs, there has been a reduction in the overall morbidity and mortality from the procedure, and it is now similar to that of other major gastrointestinal surgeries when performed in specialized centres. Morbidity has a negative impact on the overall survival in certain cancers (including colorectal cancer) and can delay the administration of systemic therapy which is equally important in other cancers like ovarian cancer which further emphasizes the importance of patient selection. It may result in a significant additional financial burden where such procedures are not under ‘insurance cover’ and are ‘out-of-pocket’ spending for patients. The 90-day morbidity and mortality capture the overall complication rate more accurately and should be recorded and reported instead of the 30-day morbidity and mortality. Early recognition and management of complications by multidisciplinary teams are needed to ‘rescue’ patients who develop complications.