Albumin Leakage Level during Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Is Associated with Major Complications

Abstract

The clinical consequences of perioperative albumin extravasation accompanying major abdominal surgery remain underexplored. We retrospectively reviewed the data of patients who underwent cytoreductive surgery (CRS) and hyperthermic intraoperative peritoneal chemotherapy (HIPEC). Parameters of albumin kinetics, including serum albumin concentration decrease (triangle Alb) and extravasated albumin level (Alb(shift)), were assessed from surgery until postoperative day (POD) 3. Logistic regression analysis identified factors associated with major complications. The association of albumin kinetics with major complications was evaluated using receiver operating characteristic (ROC) curve analysis. Serum albumin levels decreased during surgery and subsequently increased. Of the 121 analyzed patients, 25 (21%) developed major complications. The triangle Alb and Alb(shift) during surgery and on POD 3 were greater in patients who developed major complications than in those who did not (12 +/- 12 vs. 6 +/- 14, p = 0.032, and 127.5 (71.9) vs. 48.5 (44.9), p < 0.001, respectively). Perioperative triangle Alb and Alb(shift) were associated with major complications. The areas under the ROC curve of Alb(shift) during the 3 days post-surgery and Alb(shift) on POD 3 were 0.843 and 0.910, respectively. Alb(shift) during the 3 days post-surgery and Alb(shift) on POD 3 were correlated with complications (p < 0.05). In conclusion, perioperative albumin loss was associated with major complications in patients undergoing CRS and HIPEC. Alb(shift) was associated with serious complications.