Treatment of hypermyoglobinemia after cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy for patients with peritoneal carcinomatosis: a cohort study on 60 patients / 中国肿瘤临床

ABSTRACT

Objective:For cancer patients who underwent extensive surgery, drastic release of myoglobin (Mb) after surgery can cause hypermyoglobinemia and related problems. This retrospective cohort study aims to summarize our experience and outcomes of 60 pa-tients with hypermyoglobinemia after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), to investi-gate the changes in postoperative Mb levels, and to explore the clinical value of Mb. Methods:This retrospective study covered 60 pa-tients with peritoneal carcinomatosis who were treated with CRS and HIPEC. All patients developed hypermyoglobinemia after opera-tion. Immediately after CRS and HIPEC, the patients were placed in a comprehensive treatment regimen consisting of hemodynamic stabilization therapies, nutritional support, anti-sepsis therapies, and psycho-physical therapies. For the treatment of hypermyoglo-binemia, intravenous injection of sodium bicarbonate solution according to the Mb level was given to the patients. Moreover, the pre-and post-operative concentrations of Mb, blood urea nitrogen (BUN), and creatinine (Cr) were evaluated. Results:Serum Mb levels af-ter CRS and HIPEC were significantly elevated and peaked on the surgery day. Prompt treatment with intravenous infusion of sodium bicarbonate solution could help decrease the serum Mb levels and alleviate potential damage. Serum Mb levels returned to normal in approximately 3-4 days. The serum BUN levels increased after operation and peaked on the fourth postoperative day. On the other hand, serum Cr levels increased 2 days after operation and began to decrease on the third postoperative day. One patient developed renal failure and sepsis and died on postoperative day 26. The other patients recovered from the surgery without major adverse events. Conclusion:Hypermyoglobinemia is a common lab abnormality after CRS and HIPEC, and serum Mb levels could be an early and sensitive indicator for dramatic disturbances in the internal milieu after surgery. Adequate treatment with sodium bicarbonate could accelerate the reduction in serum Mb levels and reduce the risk for major organ damages.