Table 3.
Panel results on items regarding HIPEC.
| Intraoperative | Agreement |
|---|---|
| HIPEC | |
| Chest tube | |
| After diaphragmatic surgery, routine prophylactic chest tube placement can be omitted. | 79% |
| Thoracic chemoperfusion | |
| Any defect in the diaphragm should be closed before start of HIPEC preventing the pleural cavity will be rinsed simultaneously. | 88% |
| Prevention of nephrotoxicity | |
| Administration of sodium thiosulfate is started with a bolus administered…. | |
| simultaneous with heating/filling the abdominal cavity (approximately 20–30 min before first dose of cisplatin) | 50% |
| 5–10 min before first dose of cisplatin | 46% |
| simultaneous with first dose of cisplatin | 4% |
| Urine output of at least 0.5 ml/kg/h should be aimed for during and after HIPEC. | 58% |
| Adequate perfusion of the kidneys should be aimed for during and after HIPEC. | 96% |
| Hemodynamics | |
| Goal-directed fluid therapy with a balanced fluid solution should be administered. | 78% |
| If a vasopressor is indicated, the use of norepinephrine is recommended. | 88% |
| Routine administration of corticosteroid should be omitted. | 85% |
| Drains | |
| Three inflow catheters and two draining catheters should be used. | 65% |
| Inflow and outflow drains should not be placed through the fascia. | 82% |
| Routine use of postoperative abdominal drain(s) should preferably be avoided. | 81% |
| Intra-abdominal temperature | |
| Intra-abdominal temperature should be monitored continuously throughout the perfusion by sensors placed in at least 3 abdominal quadrants. | 95% |
| Temperature of the perfusate should be > 40.5 °C < 42.5 °C. | 88% |
| Stirring | |
| The HIPEC perfusate should be manipulated manually throughout the perfusion. | 63% |
| Plastic sheet * | |
| The wound and retractor should be covered by a plastic hood. | 85% |
| Core temperature * | |
| What measures can be taken to anticipate for a rise in core temperature? | |
| Switch off hotlines | 100% |
| Switch off bear hugger | 100% |
| Switch off warming mattress | 97% |
| Lower room temperature | 55% |
| Ice bags in the neck of a patient | 13% |
| Bowel anastomoses | |
| .… is preferably created after HIPEC. | |
| Low rectal anastomosis | 80% |
| Colon anastomosis | 75% |
| Small bowel anastomosis | 68% |
| Closing skin * | |
| The choice to use skin sutures or staples to close the skin is not affected by the addition of HIPEC to CRS. | 100% |
Note: The bold values represent items for which ≥ 75% of the panel members chose the same option (=consensus). Valid answers: “can't judge (unqualified to answer)” excluded.