ABSTRACT
The immediate postoperative care of patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) involves the continued management of the many issues requiring intraoperative attention. Postoperative cardiovascular stress, increased oxygen requirements, ongoing large fluid shifts as well as the risk of coagulopathy and bleeding are frequently best managed in a critical care setting. Intra-operative factors such as duration of surgery, peritoneal cancer index, large-volume blood loss, a high intravenous fluid requirement and a greater number of visceral resections and/or peritonectomies should precipitate critical care admission. Many patients undergoing CRS and HIPEC will have pre-existing respiratory conditions such as chronic obstructive pulmonary disease, bronchiectasis, asthma or respiratory muscle weakness secondary to malnutrition. A large proportion of patients will require circulatory support in the first hours post-operation. Coagulation tests may remain abnormal for up to 5 days post-operation and require continued attention. Nutritional support is required for all patients following surgery.
