Next Article in Journal
Extracorporeal Membrane Oxygenation for Respiratory Failure: A Narrative Review
Next Article in Special Issue
Morbidity and Mortality after Cytoreductive Surgery and HIPEC in a National Reference Center: A Six-Year Experience under Independent Evaluation
Previous Article in Journal
Simultaneous Muraine Sutures and Excimer Laser-Assisted Penetrating Keratoplasty for Acute Keratoconus
Previous Article in Special Issue
Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) in the Treatment of Gastric Cancer: Feasibility, Efficacy and Safety—A Systematic Review and Meta-Analysis
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
JCM
Volume 13
Issue 13
10.3390/jcm13133793
jcm-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Systematic Review

Nephrotoxicity Associated with Cytoreductive Surgery Combined with Cisplatin-Based Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Malignant Disease: A Systematic Review and Meta-Analysis

by
Cristián Grillo-Marín
1,2,3,
Cristina Antón-Rodríguez
2,
Lola Prieto
2,
Gloria Ortega-Pérez
4 and
Santiago González-Moreno
4,*
1
Department of General Surgery, Hospital Universitario Puerta de Hierro, Calle Joaquín Rodrigo 1, 28222 Majadahonda, Spain
2
Unidad de Apoyo a la Investigación, Facultad de Medicina, Universidad Francisco de Vitoria M-515, km 1, 800, 28223 Pozuelo de Alarcón, Spain
3
MD Anderson Cancer Center, Madrid Spain Foundation, Calle Arturo Soria 270, 28033 Madrid, Spain
4
Department of Surgical Oncology, Peritoneal Surface Oncology Program, MD Anderson Cancer Center, Calle Arturo Soria 270, 28033 Madrid, Spain
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2024, 13(13), 3793; https://doi.org/10.3390/jcm13133793
Submission received: 5 May 2024 / Revised: 14 June 2024 / Accepted: 20 June 2024 / Published: 28 June 2024
(This article belongs to the Special Issue Peritoneal Carcinomatosis: Current Treatment and Future Options)
Browse Figures
Versions Notes

Abstract

:
Background: Cisplatin is employed in hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery (CRS) for peritoneal surface malignancies (PSMs). The main concern regarding intraperitoneal cisplatin administration is nephrotoxicity. Numerous reports in this context are available. Our objective was to conduct a systematic review and meta-analysis to assess cisplatin-based HIPEC-related nephrotoxicity (CHRN). Methods: A systematic literature review on CHRN after CRS for the treatment of PSMs was performed. The literature search was carried out using Medline, Cochrane, and Embase. The last day of the search was 23 October 2023. PRISMA guidelines were used. A meta-analysis was then conducted. The main endpoint was the incidence of acute and chronic renal impairment after CHRN. Secondary endpoints included the potential impact of several clinical variables on the primary endpoint and a critical appraisal of the different renal impairment scales employed. Results: Our study included 26 articles with a total sample of 1473 patients. The incidence of acute kidney injury (AKI) was 18.6% (95% CI: 13.6–25%, range of true effects 3–59%). For chronic kidney disease, it was 7% (95% CI: 3–15.3%, range of true effects 1–53%). The variables that statistically influenced these results were the scale used to measure renal insufficiency, the use of nephroprotective agents, and the presence of pre-existing renal disease. Conclusions: The reported incidence of renal impairment following cisplatin-based HIPEC is highly variable. The incidence of renal failure obtained in this meta-analysis should be used as a reference for subsequent reports on this topic. Further prospective studies are warranted to establish optimal and standardized management.

1. Introduction

Peritoneal surface malignancies (PSMs) are one of the most significant clinical challenges in modern oncology. Ovarian cancer ranks as the third most prevalent gynecological [1] malignancy in women, with approximately 75% of cases being diagnosed at advanced stages (IIIB–IV), which feature peritoneal metastases (PMs) [2]. In gastric cancer patients [3], PMs are present in 5–20% of cases eligible for potentially curative resection. PMs from colorectal origin are common, affecting 10–30% [4] of patients overall and approximately 7–8% at the time of primary surgery.
During the last decades, the use of hyperthermic intraperitoneal chemotherapy (HIPEC) after complete cytoreductive surgery (CRS) has become an effective therapeutical strategy for peritoneal surface malignancies. Cisplatin is among the chemotherapeutic drugs most commonly employed in HIPEC, either alone or in combination with other agents (i.e., mitomycin C, doxorubicin). It shows one of the best profiles for this use given its depth of penetration in the tumor nodules ranging from 1 to 5 mm [5] and its cytotoxic synergy with hyperthermia.
Cisplatin [6] (cis-diaminodicloroplatino(II), CDDP) is an alkylating agent widely used for the treatment of different tumors. It has demonstrated effectiveness in neoplasms of gastrointestinal and gynecological origin. CDDP administration may cause ototoxicity, neurotoxicity, or vomiting. However, its main concerning side-effect is nephrotoxicity, which may appear either after systemic or intraperitoneal administration. The incidence of renal injury following the intraperitoneal administration of CDDP exhibits considerable variability, with reported rates [7] ranging from 3% to 48% across different series. CDDP is known to cause proximal renal tubular damage resulting in subsequent acute or subacute tubular necrosis which may progress to acute renal failure requiring temporary dialysis or, furthermore, chronic renal failure. Different agents are being used to prevent cisplatin-induced nephrotoxicity secondary to HIPEC with CDDP, like sodium thiosulfate, cilastatin or amifostine, but no definitive evidence or standardized protocols about their use has been established.
Two pivotal phase III trials emerged in 2023 establishing the role of HIPEC with CDDP for PMs from epithelial ovarian cancer in two specific scenarios: interval CRS after neoadjuvant therapy (OVHIPEC-1 [8]) and platinum-sensitive peritoneal relapse (CHIPOR [9]). The ten-year [10] follow-up results from OVHIPEC-1 confirmed the overall and disease-free survival benefit of HIPEC with CDDP in FIGO stage III ovarian cancer after CRS. Furthermore, the OVHIPEC-2 trial is currently studying its role in upfront CRS for this disease. Several studies are pending publication with promising results on various cancer types. Conversely, a significant rise in the adoption of this treatment strategy in regular clinical practice is to be expected in the near- to mid-term future.
Although CRS and HIPEC are curative-intent oncological therapeutic approaches, patients usually require additional systemic chemotherapy. Consequently, the preservation of an optimal renal function is essential for comprehensive patient care. The actual incidence of cisplatin-induced nephrotoxicity after HIPEC has not been completely established, since its figures and the renal impairment scales used in different publications are highly heterogeneous. Understanding its safety range in a context of its expected rise in clinical practice use is fundamental in order to standardize safe treatment protocols.

2. Materials and Methods

We performed a systematic literature review and meta-analysis to determine the incidence of CDDP-based HIPEC-induced renal toxicity. Secondary aims were to explore different nephroprotective practices used in this context and the assessment of the influence of different clinical variables on reported nephrotoxicity, including the variability of the renal impairment scales employed.
The study protocol was submitted to the PROSPERO [11] database (registered as CRD42021251338). This systematic review is compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [12].

2.1. Data Collection

The literature search was performed using the MEDLINE, Cochrane, and EMBASE databases. The last search was performed on 23 October 2023. The following free-text terms and Medical Subject Headings (MeSH) and their combinations were used: “hyperthermic intraperitoneal chemotherapy”, “hyperthermic”, “intraperitoneal”, “chemotherapy”, and “kidney”.

2.2. Eligibility Criteria

The included studies are observational studies (prospective or retrospective), along with randomized and non-randomized clinical trials involving more than 10 participants aged 18 years or older. Enrolled patients must have a diagnosis of peritoneal malignant disease, either primary or metastatic, treated with cytoreductive surgery and cisplatin-based HIPEC. Those treated with a combination of cisplatin and doxorubicin were admitted due to doxorubicin’s [13] toxicity profile, which does not include renal impairment, contrary to mitomycin C [14]. Therefore, for the purpose of this paper, the term “cisplatin-based HIPEC” includes cisplatin alone and combinations of cisplatin and doxorubicin. Letters, case reports, editorials, cohorts with fewer than 10 patients, studies without full-text article availability, and studies written in non-English languages were excluded.
Reported outcomes had to include information regarding and incidence of renal impairment according to an objective renal impairment scale. These included the Kidney Disease Improving Global Outcomes (KDIGO) [15], Acute Kidney Injury Network (AKIN) [16], Risk, Injury, Failure, Loss, and End-Stage (RIFLE) [16], Clavien–Dindo [17], or National Cancer Institute Common Toxicity Criteria for Adverse Effects (CTCAE) [18] version 5.0 classifications.

2.3. Study Selection and Data Extraction

All the identified studies were peer-reviewed in couples after deleting duplicates. Firstly, double-blind title and abstract screening was performed (CA and LP). Subsequently, full-text study assessment was carried out identifying which studies fulfilled all the inclusion criteria (CG and SG). Dissensions were resolved by a third reviewer (GO). This procedure was performed using Rayyan Legacy [19] free software. Later, data extraction including the variables listed in Table 1 was performed (CG).

2.4. Outcome Measures

The primary endpoint of this systematic review and meta-analysis is the incidence of renal impairment, including both acute and chronic disfunction. To assess secondary outcomes, i.e., various clinical variables that may influence the incidence of renal impairment following HIPEC, several subgroup analyses were conducted. The following clusters were investigated: nephroprotective strategies, chemotherapeutic agents employed for HIPEC, dosage of cisplatin administered, renal impairment grading scale employed, etiology of PSM, pre-existing renal conditions, gender and age distribution, as well as study design.
Some of the included studies directly compare, in two arms, the use or non-use of pharmacological nephroprotection strategies. In order to evaluate whether this intervention influences the incidence of renal impairment, a specific interventional comparison meta-analysis was conducted in addition to the overall study.

2.5. Statistical Analysis

After data extraction, a comprehensive study of the incidence of acute renal failure following CRS and cisplatin-based HIPEC was conducted, followed by a subgroup analysis, as described earlier. A one-arm statistical analysis was conducted using Comprehensive Meta-Analysis Version 4 software [20]. Revman 5 [21] was utilized for two-arm meta-analysis to evaluate the relative risk of AKI with or without nephroprotection.
The random-effects model was employed for the analysis [22], under the assumption that the studies included represent a random sample from a broader universe of potential studies, and that the results will be extrapolated to that universe. Significance was established at a 95% confidence interval (CI), with p < 0.05 considered statistically significant. Heterogeneity analysis was performed using the I-squared (I2) statistic, which provides a percentage indicating the proportion of variance in the observed effects attributable to true effects rather than sampling errors. The overall analysis also includes the predictive interval, in which the incidence of all the 95% comparable population falls assuming that true effects are normally distributed.

2.6. Methodological Quality of the Included Studies and Risk of Bias Assessment

Following the Cochrane recommendations, the Joanna Briggs Institute (JBI) Critical Appraisal tool for use in systematic reviews of randomized [23] and non-randomized clinical trials [24], case series [25], cohort studies, and case-control studies [26] was used for methodological quality (risk of bias) study assessment. Each study was assessed twice based on the risk classification criteria. Studies with positive answers ≤49% were considered to have a high risk of bias; studies with scores between 50–69% were classified with a moderate risk of bias; and those with scores above 70% were categorized as studies with a low risk of bias.

3. Results

A total of 572 records were found. After deleting duplicates, 472 records remained for assessment. First screening by title and abstract excluded 352 records, leaving 120 articles for full-text assessment. Finally, 27 studies were included for qualitive synthesis and 26 for quantitative synthesis. The reason why one article [27] was excluded for quantitative synthesis is that the data reported were aggregated and therefore could not be discretely analyzed.
The reasons for the exclusion of 93 studies during the full-text assessment for eligibility along with the overall study selection process are shown in the PRISMA diagram (Figure 1), for more detail see Supplementary Material [7,10,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112,113,114,115,116,117].

3.1. Characteristics of Included Studies

There were eleven cohort studies, one cases series, two case-control studies, five non-randomized clinical trials, and one randomized clinical trial (Table 2) Regarding the chemotherapeutic regimens utilized during HIPEC, four studies employed a combination of cisplatin and doxorubicin, twenty used cisplatin alone, and two studies used both in different arms (Liesenfeld et al. [117] and Somashekhar et al. [118]). Regarding nephroprotective strategies, four studies employed sodium thiosulfate and two used amifostine. In four studies (Lim et al. [119]; Laplace et al. [6].; Senguttuvan et al. [120]; and Glennon et al. [121]), the incidence of renal failure following the intervention is directly compared in two separate arms. Various criteria for renal impairment assessment were utilized: RIFLE was employed in six instances, WHO and AKIN were each used once, CTCAE nine times, Clavien–Dindo in three studies, and KDIGO four times.

3.2. Assessment of Risk of Bias

The overall risk of bias in the analyzed studies was low, showing a high percentage of positive answers to the JBI Critical Appraisal Tools assessment (Table 3A–D). Three non-randomized clinical trials had a moderate risk of bias (Table 3E). In these studies, negative evaluations were associated with the lack of a control group. Likewise, unclear responses in studies with moderate bias were linked to the lack of information regarding appropriate group comparisons.

3.3. Quantitative Synthesis

After analyzing the 26 studies included in the meta-analysis, a total of 1473 patients who underwent CRS followed by HIPEC based on cisplatin, as defined above, were available for analysis.

Primary Endpoint: Incidence of Acute and Chronic Renal Impairment

The obtained results reflect an overall acute kidney injury (AKI, Figure 2A) incidence of 18.6% (95% CI: 13.6–25%). The observed high heterogeneity (I2 = 82) is reflected in a wide range of true effects, producing an expanded predictive interval of 3–59%. (Figure 2B). This suggests that, by eliminating potential sources of error and bias through mathematical modeling, the incidence of AKI following cisplatin-based HIPEC would fall within the range of 3% to 59%. The I-squared (I2) statistic reflects that 82% of the variance in the observed effects reflects variance in true effects rather than sampling error.
Another primary endpoint of this meta-analysis is the estimation of the global incidence of chronic kidney disease (CKD) following the intervention (Figure 3A). The results reveal a CKD rate of 7% (95% CI: 3–15.3%). Similarly to the AKI rate, the observed heterogeneity is high (I2 = 75.89%). When calculating the range of true effects (Figure 3B), the CKD incidence would fall between 1–53%.
Given the high heterogeneity and the wide renal impairment range, the incidence rate has been disaggregated based on variables considered of interest for its possible impact on the observed effect. These variables (Table 1) are HIPEC regimen, cisplatin dose, HIPEC duration, etiology of PSM, incidence of acute renal injury with or without nephroprotection (single-arm or double-arm comparative studies), pre-existing chronic renal disease, and scale of renal impairment used. To carry out this analysis, some variables have been categorized. The breakdown analysis based on the previously mentioned variables is shown in Table 4. Among them, two yield statically significant results: the scale used to measure AKI and previous chronic kidney disease.
Regarding the use of renal insufficiency scales, the overall results (Table 4) obtained show that there are significant differences between the AKI incidences among the scales employed for assessing renal failure. This is additionally depicted in the forest plot shown in Figure 4.
When conducting a variable effects analysis, it is observed that the presence of CKD is a protective factor against (Figure 5) the occurrence of acute renal failure following CRS and cisplatin-based HIPEC. Previous chronic kidney disease, regardless of its origin, may influence the use of cisplatin as the drug of choice for HIPEC. Some strategies employed to prevent AKI in patients with CKD include dose reduction. Alonso et al. [7] and Chen et al. [58] reduced the cisplatin dose by 25% in this subgroup of patients, although they did not specify in their analysis the number of patients with previous renal pathology included.
A third variable with significant impact on the incidence of renal impairment is the use of nephroprotection, regardless of whether it is ST or amifostine (Figure 6). The overall results of the use or non-use of nephroprotectors yield non-significant data. However, if we exclusively analyze studies in which a comparative design is employed, with one arm using a renal function preservation strategy and the other without it, the results differ (Figure 7). We obtain a relative risk of AKI of 7% (95% CI: 2–29%, p = 0.0003), favoring the use of nephroprotection. All included studies with a comparative group have a low risk of bias, but their designs vary: Laplace 2020 is an observational cohort study, Glennon 2021 is a case-control study, Senguttuvan 2023 is a non-randomized clinical trial, and Lim 2022 is a randomized clinical trial.
The remaining variables investigated do not exhibit a directly significant relationship with the incidence of AKI following cisplatin-based HIPEC administration, as shown in Table 4. Related figures are available in Supplementary Materials.

4. Discussion

To our knowledge, this is the first reported systematic review and meta-analysis on nephrotoxicity after complete CRS followed by cisplatin-based HIPEC. Our main goal was to determine the incidence of renal impairment (acute and chronic) associated with this treatment so that it can serve as a reference for future studies on this topic and for practice improvement or benchmarking. Additionally, we analyzed several variables that could influence the observed rates of acute and chronic renal impairment.
The unprecedented reported survival benefit by van Driel et al. in the OVIHIPEC-1 randomized clinical trial [8,10] is giving way to an increasing implementation of HIPEC with cisplatin in interval cytoreductive surgery for FIGO stage III epithelial ovarian cancer. The report of the CHIPOR trial by Classe et al. [9] (only available in abstract format at the time of writing this article), likewise showing significant survival benefits for peritoneal recurrence following induction systemic chemotherapy in this disease, adds to this phenomenon. This underscores the importance of studying short- and long-term renal toxicity following cisplatin-based HIPEC, its most concerning adverse effect. Interestingly, the dose of cisplatin employed differeed between both studies (100 mg/m2 in OVHIPEC-1 and 75 mg/m2 in CHIPOR) and neither trial specifically reported the incidence of renal impairment. For this reason, they are not included in this meta-analysis. PSOGI recently published a consensus on HIPEC regimens [140], recommending the use of the OVHIPEC-1 protocol (100 mg/m2 fractionated in three doses together with intravenous ST) for cisplatin-based HIPEC in epithelial ovarian cancer. Several clinical trials are underway using HIPEC with different chemotherapeutic drugs to prevent or treat PSMs from various origins, including OVHIPEC-2, which explores the use of cisplatin-based HIPEC in epithelial ovarian cancer in the upfront setting.
Reports specifically on renal impairment following cisplatin-based HIPEC are relatively scarce compared with the broad body of literature on HIPEC and are highly heterogeneous. Since awareness of this adverse effect is needed, a clear idea of its magnitude is warranted. Our meta-analysis shows an incidence of 18.7% in AKI and 7% in CKD. The observed broad range in true effects makes interpretation difficult; it becomes challenging to make a clinical decision regarding a procedure associated with such a wide-ranging serious consequence. While AKI is oftentimes manageable and transitory, a 7% incidence of chronic kidney damage following a curative-intent procedure needs to be brought to the drawing board when indicating cisplatin-based HIPEC.
Therefore, nephroprotection should be considered when using cisplatin-based HIPEC. Van Driel et al. [8] used as part of their HIPEC protocol an intravenous infusion of ST aimed at preventing renal impairment. However, CHIPOR did not use nephroprotection. ST is indicated in the treatment of cyanide poisoning. The United States Food and Drug Administration (FDA) and the European Medicines Agency (EMA) recently approved (September 2022 and March 2023, respectively) the intravenous infusion of ST to reduce hearing loss caused by cisplatin for non-metastatic solid tumors in pediatric patients. By extrapolation, off-label use of ST for renal protection is certainly an option, the same way it is used to treat calciphylaxis. Several other strategies have been reported to prevent cisplatin-based HIPEC-induced renal injury. These include the use of other intravenous nephroprotective agents (i.e., amifostine [123], cilastatin [110], forced diuresis and/or aggressive pre-hydration [141]). It is of utmost importance to keep in mind that many of the patients undergoing cisplatin-based HIPEC are likely to require additional systemic chemotherapy, making long-term organ functional preservation crucial.
Laplace et al. [6] published a prospective cohort compared with a retrospective cohort study with 66 patients diagnosed with PSMs of various origins that reflects the nephroprotective capability of ST after cisplatin-based HIPEC. The present systematic review and meta-analysis included studies using ST and amifostine, not showing differences in their capacity to prevent renal impairment. However, renal impairment was not their primary endpoint, and the assessment and categorization of renal damage was not homogeneous or standardized. In our study, the employment of nephroprotection only emerged as a significant variable impacting the incidence of renal failure when we specifically considered the studies that have two comparative arms, one using renal protection and a second arm without it. In this instance, the result differed from the overall findings, which showed no difference with the use of nephroprotection.
The most plausible explanation is that these studies were specifically designed to assess the incidence of renal failure as their primary endpoint, as an important detail that can exert a significant impact on their outcomes. All these studies include ST as nephroprotective agent and were published after the release of the initial report of van Driel et al.’s [8] study in 2018. The etiology of PSM in these studies, although varied, is mainly ovarian cancer [6,119,120,121]. Regarding the doses of cisplatin used, they range from 50 mg/m2 to 100 mg/m2, and the duration of HIPEC varies between 60 and 90 min. The rate of acute renal failure is expressed using CTCAE (Sengutuvan et al. [120] and Lim et al. [119]), while Laplace et al. [6]. use the WHO scale, and Glennon et al. [121] use KDIGO.
The renal impairment scale used to report cisplatin-based HIPEC nephrotoxicity was identified as one of the statistically significant variables impacting renal impairment incidence. To explain these findings, we searched the literature for a comparison among the different scales employed in the reports included in our meta-analysis. Although not established for CRS and HIPEC patients, it has been made for cardiac surgery patients [142], stating that RIFLE was superior to KDIGO and AKIN in terms of prognostic value for predicting mortality after isolated coronary artery bypass surgery. Additionally, Erdost et al. [143] compared these same three classifications for patients undergoing liver transplantation, another major abdominal surgery. Similarly to our findings, the results showed that AKI incidence varied depending on the scale used, and the perioperative risk factors for AKI changes with the scale as well.
These diverse renal impairment scales or classifications employed in the articles we reviewed establish different cut-off serum creatinine and/or urine output values or the need for renal replacement therapy, dialysis, in order to transition from one category to the next. They also differ in the consideration of both acute and chronic renal insufficiency. For example, when evaluating AKI using the Clavien–Dindo scale, distinguishing between grades 1 or 2 is challenging because it does not classify AKI until dialysis is required; the only difference between grade 1 and 2 is the pharmacological medical management. Exploring deeper into this comparison, AKIN 1 and 2 are analogous to CTCAE 2; meanwhile, AKIN 3 corresponds to CTCAE 3 and 4. The RIFLE scale uses cut-off points to establish Risk, Injury, and Failure stages, aligning with AKIN’s. Loss and end-stage corresponds to CKD.
Descriptive and graphical comparisons between all scales are available in Table 5 and Figure 8, respectively. The heterogeneity in the reported data derived from this diversity makes a direct comparison of the studies considered in the present meta-analysis difficult.
Standardization in the reporting of adverse effects within the field of surgical oncology is necessary. The use of the CTCAE scale was proposed by Younan et al. [144] as a result of an expert international consensus led by the PSOGI. However, it is true that the traditional use of the Clavien–Dindo classification in surgical services remains a practice difficult to change.
Finally, numerous clinical trials exclude patients diagnosed with any chronic organ dysfunction such as chronic kidney disease. Our study rendered an intriguing finding in that the presence of previous CKD acted as a protective factor for AKI following cisplatin-based HIPEC, with an incidence of AKI in previous CKD patients statistically significantly lower than in the non-previous CKD patient group. Several reasons might explain this finding, including the use of a cisplatin dose reduction or a more intensive monitoring of postoperative renal function in these patient groups. It is imperative to establish whether these patients could benefit from HIPEC with a presurgical organ preservation strategy. Multidisciplinary tumor conferences play a crucial role in these scenarios, where all care providers from each involved medical field must contribute, ensuring that the maximum possible number of patients can benefit from the best available treatment options.

Strengths and Limitations

This study is the first meta-analysis and systematic review that establishes the incidence of renal impairment, acute and chronic, after cisplatin-based HIPEC for patients with PSMs. It should serve as a reference for practice improvement and future reports on this topic. The methodology adhered strictly to PRISMA recommendations.
While the findings are promising and state the need for future research, it is essential to acknowledge certain limitations. Primarily, most of the included studies include retrospective cohorts and very few are non-randomized clinical trials. Additionally, the design of the studies that met the inclusion criteria were quite diverse: sixteen cohort studies (Table 3A), two case-control studies (Table 3B), one case series (Table 3C), one randomized clinical trial (Table 3D), and seven non-randomized clinical trials. However, despite the different designs, no significant differences were found when analyzing the incidence of renal impairment based on the study design used. However, although potential biases may exist, impacting consistency, the overall risk of bias of the included studies, as evaluated by JBI Critical Appraisal Tools assessment, was low.
Additionally, the high heterogeneity observed in this research complicates result interpretation. Factors like sample size, study design, classification of renal impairment, or studies not specifically designed to evaluate adverse events as the primary endpoint may influence results. These limitations emphasize the importance of improved adverse events reporting using standardized criteria and better-designed clinical trials.

5. Conclusions

The results of this study reveal that the reported incidence of renal impairment following cisplatin-based HIPEC administration is highly variable because of the heterogeneity in the renal impairment scales employed. Of note, chronic renal damage can occur in 7% of patients. The use of ST and other nephroprotective drugs appears to be beneficial as a preventive strategy for acute renal injury; however, further studies are necessary to establish the optimal nephroprotective strategy in this context. It is essential to standardize the scientific communication of pharmacological toxicity to obtain higher levels of evidence that enable the standardization of results and techniques.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/jcm13133793/s1, File S1: Figures results, Search strategy and Study exclusion reasons in full-text articles assessed for eligibility.

Author Contributions

Concept and design: S.G.-M., C.G.-M., C.A.-R. and L.P.; Systematic review: S.G.-M., C.G.-M., C.A.-R., G.O.-P. and L.P.; Data extraction: C.G.-M.; Statistical analysis: L.P. and C.A.-R.; Manuscript writing: S.G.-M., C.G.-M., C.A.-R. and L.P. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

The original data presented in this study are openly available in Medline, Cochrane, and EMBASE.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. World Health Organization. Available online: https://gco.iarc.fr/overtime/en/dataviz/bars?sexes=2&sort_by=value0&mode=cancer&key=crude_rate&years=2016&populations=84000 (accessed on 9 April 2024).
  2. Delvallée, J.; Rossard, L.; Bendifallah, S.; Touboul, C.; Collinet, P.; Bricou, A.; Huchon, C.; Lavoue, V.; Body, G.; Ouldamer, L. Accuracy of Peritoneal Carcinomatosis Extent Diagnosis by Initial FDG PET CT in Epithelial Ovarian Cancer: A Multicentre Study of the FRANCOGYN Research Group. J. Gynecol. Obstet. Hum. Reprod. 2020, 49, 101867. [Google Scholar] [CrossRef] [PubMed]
  3. Coccolini, F. Peritoneal Carcinomatosis. World J. Gastroenterol. 2013, 19, 6979. [Google Scholar] [CrossRef]
  4. Koppe, M.J.; Boerman, O.C.; Oyen, W.J.G.; Bleichrodt, R.P. Peritoneal Carcinomatosis of Colorectal Origin: Incidence and Current Treatment Strategies. Ann. Surg. 2006, 243, 212–222. [Google Scholar] [CrossRef] [PubMed]
  5. De Bree, E.; Michelakis, D.; Stamatiou, D.; Romanos, J.; Zoras, O. Pharmacological Principles of Intraperitoneal and Bidirectional Chemotherapy. Pleura Peritoneum 2017, 2, 47–62. [Google Scholar] [CrossRef] [PubMed]
  6. Laplace, N.; Kepenekian, V.; Friggeri, A.; Vassal, O.; Ranchon, F.; Rioufol, C.; Gertych, W.; Villeneuve, L.; Glehen, O.; Bakrin, N. Sodium Thiosulfate Protects from Renal Impairement Following Hyperthermic Intraperitoneal Chemotherapy (HIPEC) with Cisplatin. Int. J. Hyperth. 2020, 37, 897–902. [Google Scholar] [CrossRef] [PubMed]
  7. Alonso, A.; Liauw, W.; Kennedy, H.; Alzahrani, N.A.; Morris, D.L. Sodium Thiosulfate during Cisplatin-Based Hyperthermic Intraperitoneal Chemotherapy Is Associated with Transient Hypernatraemia without Clinical Sequelae. Pleura Peritoneum 2022, 7, 87–93. [Google Scholar] [CrossRef] [PubMed]
  8. Van Driel, W.J.; Koole, S.N.; Sikorska, K.; Schagen van Leeuwen, J.H.; Schreuder, H.W.R.; Hermans, R.H.M.; de Hingh, I.H.J.T.; van der Velden, J.; Arts, H.J.; Massuger, L.F.A.G.; et al. Hyperthermic Intraperitoneal Chemotherapy in Ovarian Cancer. N. Engl. J. Med. 2018, 378, 230–240. [Google Scholar] [CrossRef]
  9. Classe, J.-M.; Meeus, P.; Leblanc, E.; Wernert, R.; Quenet, F.; Marchal, F.; Houvenaeghel, G.; Bats, A.-S.; Ferron, G.; Brigand, C.; et al. Hyperthermic Intraperitoneal Chemotherapy in Platinum-Sensitive Relapsed Epithelial Ovarian Cancer: The CHIPOR Randomized Phase III Trial. J. Clin. Oncol. 2023, 41, 5510. [Google Scholar] [CrossRef]
  10. Aronson, S.L.; Lopez-Yurda, M.; Koole, S.N.; van Leeuwen, J.H.S.; Schreuder, H.W.R.; Hermans, R.H.M.; de Hingh, I.H.J.T.; van Gent, M.D.J.M.; Arts, H.J.G.; Ham, M.A.P.C.V.; et al. Cytoreductive Surgery with or without Hyperthermic Intraperitoneal Chemotherapy in Patients with Advanced Ovarian Cancer (OVHIPEC-1): Final Survival Analysis of a Randomised, Controlled, Phase 3 Trial. Lancet Oncol. 2023, 24, 1109–1118. [Google Scholar] [CrossRef]
  11. PROSPERO. International Prospective Register of Systematic Reviews. Available online: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=251338 (accessed on 29 April 2024).
  12. Page, M.J.; McKenzie, J.E.; Bossuyt, P.M.; Boutron, I.; Hoffmann, T.C.; Mulrow, C.D.; Shamseer, L.; Tetzlaff, J.M.; Akl, E.A.; Brennan, S.E.; et al. The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews. BMJ 2021, 372, n71. [Google Scholar] [CrossRef]
  13. Johnson-Arbor, K.; Dubey, R. Doxorubicin. In StatPearls; StatPearls Publishing: Treasure Island, FL, USA, 2024. Available online: https://www.ncbi.nlm.nih.gov/books/NBK459232/ (accessed on 17 April 2024).
  14. Sinawe, H.; Casadesus, D. Mitomycin. In StatPearls; StatPearls Publishing: Treasure Island, FL, USA, 2024. Available online: https://www.ncbi.nlm.nih.gov/books/NBK562249/ (accessed on 17 April 2024).
  15. Machado, M.N.; Nakazone, M.A.; Maia, L.N. Acute kidney injury based on KDIGO (Kidney Disease Improving Global Outcomes) criteria in patients with elevated baseline serum creatinine undergoing cardiac surgery. Rev. Bras. Cir. Cardiovasc. 2014, 29, 299–307. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
  16. Lopes, J.A.; Jorge, S. The RIFLE and AKIN Classifications for Acute Kidney Injury: A Critical and Comprehensive Review. Clin. Kidney J. 2013, 6, 8–14. [Google Scholar] [CrossRef]
  17. Dindo, D.; Demartines, N.; Clavien, P.-A. Classification of Surgical Complications. Ann. Surg. 2004, 240, 205–213. [Google Scholar] [CrossRef]
  18. Common Terminology Criteria for Adverse Events (CTCAE); Version 5.0; US Department of Health and Human Services: Washington, DC, USA, 2017. Available online: https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/ctcae_v5_quick_reference_5x7.pdf (accessed on 1 March 2024).
  19. Ouzzani, M.; Hammady, H.; Fedorowicz, Z.; Elmagarmid, A. Rayyan—A web and mobile app for systematic reviews. Syst. Rev. 2016, 5, 210. [Google Scholar] [CrossRef]
  20. Borenstein, M.; Hedges, L.; Higgins, J.; Rothstein, H. Comprehensive Meta-Analysis; Version 4; Biostat: Englewood, NJ, USA, 2022. [Google Scholar]
  21. Review Manager (RevMan); Version 5.4.1; The Cochrane Collaboration: London, UK, 2020; Available online: https://revman.cochrane.org/ (accessed on 17 April 2024).
  22. Higgins, J.P.T.; Thomas, J. (Eds.) Cochrane Handbook for Systematic Reviews, 2nd ed.; Wiley: Hoboken, NJ, USA, 2019. [Google Scholar]
  23. Barker, T.H.; Stone, J.C.; Sears, K.; Klugar, M.; Tufanaru, C.; Leonardi-Bee, J.; Aromataris, E.; Munn, Z. The revised JBI critical appraisal tool for the assessment of risk of bias for randomized controlled trials. JBI Evid. Synth. 2023, 21, 494–506. [Google Scholar] [CrossRef]
  24. Tufanaru, C.; Munn, Z.; Aromataris, E.; Campbell, J.; Hopp, L. Chapter 3: Systematic reviews of effectiveness. In JBI Manual for Evidence Synthesis; Aromataris, E., Munn, Z., Eds.; JBI: Miami, FL, USA, 2020. [Google Scholar]
  25. Munn, Z.; Barker, T.H.; Moola, S.; Tufanaru, C.; Stern, C.; McArthur, A.; Stephenson, M.; Aromataris, E. Methodological Quality of Case Series Studies. JBI Database Syst. Rev. Implement. Rep. 2020, 18, 2127–2133. [Google Scholar] [CrossRef]
  26. Moola, S.; Munn, Z.; Tufanaru, C.; Aromataris, E.; Sears, K.; Sfetcu, R.; Currie, M.; Qureshi, R.; Mattis, P.; Lisy, K.; et al. Chapter 7: Systematic reviews of etiology and risk. In JBI Manual for Evidence Synthesis; Aromataris, E., Munn, Z., Eds.; JBI: Miami, FL, USA, 2020. [Google Scholar]
  27. Gouy, S.; Ferron, G.; Glehen, O.; Bayar, A.; Marchal, F.; Pomel, C.; Quenet, F.; Bereder, J.; Le Deley, M.; Morice, P. Results of a Multicenter Phase I Dose-Finding Trial of Hyperthermic Intraperitoneal Cisplatin after Neoadjuvant Chemotherapy and Complete Cytoreductive Surgery and Followed by Maintenance Bevacizumab in Initially Unresectable Ovarian Cancer. Gynecol. Oncol. 2016, 142, 237–242. [Google Scholar] [CrossRef]
  28. Acs, M.; Gerken, M.; Gajic, I.; Mayr, M.; Zustin, J.; Piso, P. Ten-year single-center experience with treatment of primary diffuse malignant peritoneal mesothelioma (DMPM) by cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Langenbecks Arch. Surg. 2022, 407, 3057–3067. [Google Scholar] [CrossRef]
  29. Kluger, M.D.; Taub, R.N.; Hesdorffer, M.; Jin, Z.; Chabot, J.A. Two-stage operative cytoreduction and intraperitoneal chemo-therapy for diffuse malignant peritoneal mesothelioma: Operative morbidity and mortality in phase i and II trials. Eur. J. Surg. Oncol. 2010, 36, 997–1003. [Google Scholar] [CrossRef] [PubMed]
  30. Akilli, H.; Gunakan, E.; Haberal, A.; Altundag, O.; Kuscu, U.E.; Taskiran, C.; Ayhan, A. Complications of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: An evaluation of 100 cases. Int. J. Gynaecol. Obstet. Off. Organ. Int. Fed. Gynaecol. Obstet. 2022, 156, 560–565. [Google Scholar] [CrossRef] [PubMed]
  31. Kowalsky, S.J.; Shuai, Y.; Hall, L.; Derby, J.; Holtzman, M.; Ongchin, M. Acute Kidney Injury Following CRS/HIPEC with High-Dose Cisplatin and Goal-Directed Intravenous Fluid Administration Strategy. Ann. Surg. Oncol. 2023, 30, S99. [Google Scholar]
  32. Almerey, T.; Gabriel, E.; Bagaria, S. Intraoperative fluid restriction for hyperthermic intraperitoneal chemotherapy (HIPEC) surgery. Ann. Surg. Oncol. 2018, 25, S141. [Google Scholar]
  33. Kurreck, A.; Gronau, F.; Alberto Vilchez, M.E.; Abels, W.; Enghard, P.; Brandl, A.; Francis, R.; Föhre, B.; Lojewski, C.; Pratschke, J.; et al. Sodium Thiosulfate Reduces Acute Kidney Injury in Patients Undergoing Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy with Cisplatin: A Single-Center Observational Study. Ann. Surg. Oncol. 2022, 29, 152–162. [Google Scholar] [CrossRef]
  34. La Manna, G.; Virzí, S.; Deraco, M.; Capelli, I.; Accorsi, A.; Dalmastri, V.; Comai, G.; Bonomi, S.; Grassi, A.; Selva, S.; et al. Tubular dysfunction after peritonectomy and chemohyperthermic treatment with cisplatin. In Vivo 2006, 20, 703–706. [Google Scholar]
  35. Arjona-Sánchez, A.; Cadenas-Febres, A.; Cabrera-Bermon, J.; Muñoz-Casares, F.C.; Casado-Adam, A.; Sánchez-Hidalgo, J.M.; López-Andreu, M.; Briceño-Delgado, J.; Rufián-Peña, S. Assessment of RIFLE and AKIN criteria to define acute renal dysfunction for HIPEC procedures for ovarian and non ovarian peritoneal malignances. Eur. J. Surg. Oncol. 2016, 42, 869–876. [Google Scholar] [CrossRef]
  36. León-Póo, M.; Bermejo, T.R.; Garate, C.O.; Polo, S.H.; Chico, P.T.; Shabaka, A. Hyperthermic intraperitoneal chemotherapy with cisplatin increases the risk of acute kidney injury compared to conventional intraperitoneal cisplatin. Nephrol. Dial. Transpl. 2023, 38, gfad063c_4934. [Google Scholar] [CrossRef]
  37. Li, X.B.; Ma, R.; Ji, Z.H.; Lin, Y.L.; Zhang, J.; Yang, Z.R.; Chen, L.-F.; Yan, F.-C.; Li, Y. Perioperative safety after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei from appendiceal origin: Experience on 254 patients from a single center. Eur. J. Surg. Oncol. 2020, 46, 600–606. [Google Scholar] [CrossRef]
  38. Ayyappan, S.; Mahajan, V.; Pai, A.; Padmanabhan, N.; Ahmad, S. A single center experience of cytoreductive surgery and hy-perthermic intraperitoneal chemotherapy procedure in peritoneal malignancy. Indian J. Surg. Oncol. 2020, 11, S16–S17. [Google Scholar]
  39. Liesenfeld, L.F.; Wagner, B.; Hillebrecht, H.C.; Brune, M.; Eckert, C.; Klose, J.; Schmidt, T.; Büchler, M.W.; Schneider, M. HIPEC-Induced Acute Kidney Injury: A Retrospective Clinical Study and Preclinical Model. Ann. Surg. Oncol. 2022, 29, 139–151. [Google Scholar] [CrossRef]
  40. Badgwell, B.; Ikoma, N.; Murphy, M.B.; Wang, X.; Estrella, J.; Roy-Chowdhuri, S.; Das, P.; Minsky, B.D.; Lano, E.; Song, S.; et al. A Phase II Trial of Cytoreduction, Gastrectomy, and Hyperthermic Intraperitoneal Perfusion with Chemotherapy for Patients with Gastric Cancer and Carcinomatosis or Positive Cytology. Ann. Surg. Oncol. 2021, 28, 258–264. [Google Scholar] [CrossRef]
  41. Liesenfeld, L.F.; Brandl, A. Influence of hyperthermic intraperitoneal chemotherapy on renal blood perfusion. Langenbecks Arch. Surg. 2023, 408, 207. [Google Scholar] [CrossRef]
  42. Bakrin, N.; Bereder, J.M.; Decullier, E.; Classe, J.M.; Msika, S.; Lorimier, G.; Abboud, K.; Meeus, P.; Ferron, G.; Quenet, F.; et al. Peritoneal carcinomatosis treated with cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for advanced ovarian carcinoma: A French multicentre retrospective cohort study of 566 patients. Eur. J. Surg. Oncol. 2013, 39, 1435–1443. [Google Scholar] [CrossRef]
  43. Llueca, A.; Ibañez, M.V.; Cascales, P.; Gil-Moreno, A.; Bebia, V.; Ponce, J.; Fernandez, S.; Arjona-Sanchez, A.; Muruzabal, J.C.; Veiga, N.; et al. Neoadjuvant Chemotherapy plus Interval Cytoreductive Surgery with or without Hyperthermic Intraperitoneal Chemotherapy (NIHIPEC) in the Treatment of Advanced Ovarian Cancer: A Multicentric Propensity Score Study. Cancers 2023, 15, 4271. [Google Scholar] [CrossRef] [PubMed]
  44. Belgrano, V.; Santori, G.; Di Domenico, S.; De Cian, F. Hipec in the management of metachronous peritoneal carcinomatosis: A single-center retrospective analysis. Eur. J. Surg. Oncol. 2016, 42, S215. [Google Scholar] [CrossRef]
  45. Lomnytska, M.; Silins, I.; Graf, W. Hyperthermic intraperithoneal chemotherapy (HIPEC) for ovarian cancer treatment: The feasibility study. Int. J. Gynecol. Cancer 2019, 29, A488–A489. [Google Scholar]
  46. Benhaim, L.; Faron, M.; Gelli, M.; Sourrouille, I.; Honoré, C.; Delhorme, J.B.; Goere, D. Survival after complete cytoreductive surgery and HIPEC for extensive pseudomyxoma peritonei. Surg. Oncol. 2019, 29, 78–83. [Google Scholar] [CrossRef]
  47. Loungnarath, R.; Causeret, S.; Bossard, N.; Faheez, M.; Sayag-Beaujard, A.C.; Brigand, C.; Gilly, F.; Glehen, O. Cytoreductive surgery with intraperitoneal chemohyperthermia for the treatment of pseudomyxoma peritonei: A prospective study. Colon Rectum. 2005, 48, 1372–1379. [Google Scholar] [CrossRef]
  48. Bhatt, A.; Kammar, P.; Mehta, S.; Damodaran, D.; Zaveri, S.; Patel, M.D.; Sinukumar, S.; Ray, M.; Seshadri, R. Chasing Rainbows? the Possibility of “Cure” in Patients with Colorectal Peritoneal Metastases Undergoing Cytoreductive Surgery and HIPEC—A Retrospective Study by INDEPSO. Indian J. Surg. Oncol. 2019, 10, 49–56. [Google Scholar] [CrossRef]
  49. Lu, P.; Fields, A.C.; Shabat, G.; Lee, K.; Irani, J.; Goldberg, J. Enhanced recovery after surgery: Improving outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: A feasibility study. Ann. Surg. Oncol. 2019, 26, S122. [Google Scholar]
  50. Bouhadjari, N.; Gabato, W.; Calabrese, D.; Msika, S.; Keita, H. Hyperthermic intraperitoneal chemotherapy with cisplatin: Amifostine prevents acute severe renal impairment. Eur. J. Surg. Oncol. 2016, 42, 219–223. [Google Scholar] [CrossRef]
  51. Macrì, A.; Arcoraci, V.; Belgrano, V.; Caldana, M.; Cioppa, T.; Costantini, B.; Cucinotta, E.; De Cian, F.; De Iaco, P.; De Manzoni, G.; et al. Short-term outcome of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Preliminary analysis of a multicentre study. Anticancer Res. 2014, 34, 5689–5693. [Google Scholar] [PubMed]
  52. Cabiling, C.C. Predictive factors of post-operative acute kidney injury after cytoreductive surgery with hyperthermic intra-peritoneal chemotherapy in patients with peritoneal carcinomatosis: A retrospective cohort study. Ann. Oncol. 2022, 33, S1605. [Google Scholar] [CrossRef]
  53. Macrì, A.; Accarpio, F.; Arcoraci, V.; Casella, F.; De Cian, F.; De Iaco, P.; Orsenigo, E.; Roviello, F.; Scambia, G.; Saladino, E.; et al. Predictors of morbidity and mortality in patients submitted to cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for ovarian carcinomatosis: A multicenter study. Pleura Perit. 2021, 6, 21–30. [Google Scholar] [CrossRef] [PubMed]
  54. Chambers, L.M.; Yao, M.; Morton, M.; Chichura, A.; Costales, A.B.; Horowitz, M.; Gruner, M.F.; Rose, P.G.; Michener, C.M.; DeBernardo, R. Perioperative outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in elderly women with epithelial ovarian cancer: Analysis of a prospective registry. Int. J. Gynecol. Cancer 2021, 31, 1021–1030. [Google Scholar] [CrossRef] [PubMed]
  55. Mehta, S.; Schwarz, L.; Spiliotis, J.; Hsieh, M.C.; Akaishi, E.H.; Goere, D.; Sugarbaker, P.H.; Baratti, D.; Quenet, F.; Bartlett, D.L.; et al. Is there an oncological interest in the combination of CRS/HIPEC for peritoneal carcinomatosis of HCC? Results of a mul-ticenter international study. Eur. J. Surg. Oncol. 2018, 44, 1786–1792. [Google Scholar] [CrossRef] [PubMed]
  56. Chen, C.Y.; Chang, H.Y.; Lu, C.H.; Chen, M.C.; Huang, T.H.; Lee, L.W.; Liao, Y.-S.; Chen, V.C.-H.; Huang, W.-S.; Ou, Y.-C.; et al. Risk factors of acute renal impairment after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Int. J. Hyperth. Off. J. Eur. Soc. Hyperthermic Oncol. N. Am. Hyperth. Group 2020, 37, 1279–1286. [Google Scholar] [CrossRef] [PubMed]
  57. Miklos, A.C.S.; Halmy, L.; Isgandarova, S.; Blaj, S.; Gerken, M.; Hormann, B.; Piso, P. Hyperthermic Intraperitoneal Chemo-therapy With Cisplatin and Doxorubicin for 90 Minutes Versus 60 Minutes After Cytoreductive Surgery (CRS). Does the 30-Minute Difference Matter? A Comparative Study in a High Volume Centre. Anticancer Res. 2022, 42, 1019–1029. [Google Scholar]
  58. Chen, K.L.; Shamavonian, R.; Karpes, J.B.; Alzahrani, N.A.; Morris, D.L. Acute kidney injury following hyperthermic intraper-itoneal chemotherapy with cisplatin. Iran. J. Basic Med. Sci. 2021, 41, 1641–1646. [Google Scholar]
  59. Mitani, Y.; Arai, Y.; Tomohiro Mitani Gohda, Y.; Yano, H.; Kondo, I.; Sakamoto, E.; Katagiri, D.; Hinoshita, F. Association of intraoperative gross hematuria with acute kidney injury after cytoreductive surgery. Pleura Peritoneum 2022, 7, 19–26. [Google Scholar] [CrossRef]
  60. ChiCTR2000038173. Neoadjuvant Hyperthermic Intraperitoneal Chemotherapy in Advanced Serous Ovairan Cancer: A Ran-domized Phase II Trial. 2020. Available online: https://www.cochranelibrary.com/central/doi/10.1002/central/CN-02239327/full (accessed on 20 May 2023).
  61. Naffouje, S.A.; Tulla, K.A.; Chorley, R.; Armstrong, N.; Salti, G.I. Acute kidney injury increases the rate of major morbidities in cytoreductive surgery and HIPEC. Ann. Med. Surg. 2018, 35, 163–168. [Google Scholar] [CrossRef]
  62. Cioppa, T.; Vaira, M.; Bing, C.; D’Amico, S.; Bruscino, A.; De Simone, M. Cytoreduction and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis from pseudomixoma peritonei. World J. Gastroenterol. 2008, 14, 6817–6823. [Google Scholar] [CrossRef]
  63. Namendys-Silva, S.; Correa-García, P.; López-Basave, H.; García-Guillén, F.; Texcocano-Becerra, J.; Herrera-Gómez, A. Organ Dysfunction in Critically Ill Cancer Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemo-therapy. Chest 2013, 144. [Google Scholar] [CrossRef]
  64. Coccolini, F.; Campanati, L.; Catena, F.; Ceni, V.; Ceresoli, M.; Cruz, J.J.; Lotti, M.; Magnone, S.; Napoli, J.; Rossetti, D.; et al. Hyperthermic intraperitoneal chemotherapy with cisplatin and paclitaxel in advanced ovarian cancer: A multicenter prospective observational study. J. Gynecol. Oncol. 2015, 26, 54–61. [Google Scholar] [CrossRef] [PubMed]
  65. Piso, P.; Nedelcut, S.D.; Rau, B.; Königsrainer, A.; Glockzin, G.; Ströhlein, M.A.; Hörbelt, R.; Pelz, J. Morbidity and Mortality Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Data from the DGAV StuDoQ Registry with 2149 Consecutive Patients. Ann. Surg. Oncol. 2019, 26, 148–154. [Google Scholar] [CrossRef]
  66. Dagel, T.; Misirlioglu, S.; Tanju, S.; Afsar, B.; Selcukbiricik, F.; Erus, S.; Vatansever, D.; Balik, E.; Taskiran, C.; Dilege, S.; et al. Hyperthermic intraperitoneal chemotherapy is an independent risk factor for development of acute kidney injury. J. BUON 2018, 23, 1528–1533. [Google Scholar] [PubMed]
  67. Praiss, A.; Moukarzel, L.; Dessources, K.; Sonoda, Y.; Roche, K.L.; Gardner, G.; William, T.; Rachel, G.; Dennis, C.; O’Cearbhaill, R.; et al. Creating a Multidisciplinary Protocol for the Administration of Hyperthermic Intraperitoneal Chemotherapy with Cis-platin: A Single-Institution Experience. Int. J. Gynecol. Cancer 2022, 32, A211. [Google Scholar]
  68. Dellinger, T.; Han, E.; Lin, W.C.; Kebria, M.; Hakim, A.; de leon, M.; Razavi, M.; Cristea, M.; Stewart, D.; Wang, E.; et al. Safety and tolerability of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in ovarian cancer: Clinical results from a phase I trial. Gynecol. Oncol. 2021, 162, S269. [Google Scholar] [CrossRef]
  69. Račkauskas, R.; Baušys, A.; Jurgaitis, J.; Paškonis, M.; Strupas, K. Initial Experience of Cytoreductive Surgery (CRS) and Hy-perthermic Intraperitoneal Chemotherapy (HIPEC) in Baltic Country Center. J. Clin. Med. 2022, 11, 5554. [Google Scholar] [CrossRef]
  70. Deo, S.; Ray, M.; Bansal, B.; Bhoriwal, S.; Bhatnagar, S.; Garg, R.; Gupta, N.; Sharma, A.; Kumar, L.; Thulkar, S.; et al. Feasibility and outcomes of cytoreductive surgery and HIPEC for peritoneal surface malignancies in low- and middle-income countries: A single-center experience of 232 cases. World J. Surg. Oncol. 2021, 19, 164. [Google Scholar] [CrossRef] [PubMed]
  71. Raft, J.; Parisot, M.; Marchal, F.; Tala, S.; Desandes, E.; Lalot, J.M.; Guillemin, F.; Longrois, D.; Meistelman, C. Impact of the hyperthermic intraperitoneal chemotherapy on the fluid-electrolytes changes and on the acid-base balance. Retentissements Hydroélectrolytiques Acidobasiques Chim. Intrapéritonéale 2010, 29, 676–681. [Google Scholar]
  72. Deraco, M.; Casali, P.; Inglese, M.G.; Baratti, D.; Pennacchioli, E.; Bertulli, R.; Kusamura, S. Peritoneal mesothelioma treated by induction chemotherapy, cytoreductive surgery, and intraperitoneal hyperthermic perfusion. J. Surg. Oncol. 2003, 83, 147–153. [Google Scholar] [CrossRef]
  73. Randle, R.W.; Ahmed, S.; Levine, E.A.; Fino, N.F.; Swett, K.R.; Stewart, J.H.; Shen, P.; Votanopoulos, K.I. Significance of diabetes on morbidity and mortality following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. J. Surg. Oncol. 2015, 111, 740–745. [Google Scholar] [CrossRef]
  74. Deraco, M.; Virzì, S.; Iusco, D.R.; Puccio, F.; MacRì, A.; Famulari, C.; Solazzo, M.; Bonomi, S.; Grassi, A.; Baratti, D.; et al. Secondary cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent epithelial ovarian cancer: A mul-ti-institutional study. BJOG Int. J. Obstet. Gynaecol. 2012, 119, 800–809. [Google Scholar] [CrossRef]
  75. Roife, D.; Powers, B.D.; Zaidi, M.Y.; Staley, C.A.; Cloyd, J.M.; Ahmed, A.; Grotz, T.; Leiting, J.; Fournier, K.; Lee, A.J.; et al. CRS/HIPEC with Major Organ Resection in Peritoneal Mesothelioma Does not Impact Major Complications or Overall Survival: A Retrospective Cohort Study of the US HIPEC Collaborative. Ann. Surg. Oncol. 2020, 27, 4996–5004. [Google Scholar] [CrossRef] [PubMed]
  76. Di Maio, F.; Fagotti, A.; Ronsini, C.; Panocchia, N.; Grandaliano, G.; Scambia, G.; Ferraro, P.M. The short and long-term effects of hyperthermic intraperitoneal chemotherapy on renal function in platinum-sensitive recurrent ovarian cancer. Nephrol. Dial. Transpl. 2020, 35, iii882. [Google Scholar] [CrossRef]
  77. Roviello, F.; Caruso, S.; Marrelli, D.; Neri, A.; Alfonso, D.S.; Pinto, E. Long-term survival in patients with peritoneal carcino-matosis treated with cytoreductive surgery and hyperthermi c intraperitoneal chemotherapy (HIPEC): Ten-year experience from a single institution. Eur. J. Surg. Oncol. 2010, 36, 1027. [Google Scholar] [CrossRef]
  78. Di Stefano, S.; Videla, C.; Carboni Bisso, I.; Las Heras, M.; Dianti, J.M.; Viaña, B.; Roman, E.S. Outcomes and complications fol-lowing cytoreductive surgery and hypertermic intraperitoneal chemotherapy: Three year experience. Intensive Care Med. Exp. 2019, 7. [Google Scholar]
  79. Rubio-López, J.D.; Durán-Martínez, M.; Moreno-Blázquez, A.; Rodríguez-Ortiz, L.; Rufián-Andújar, B.; Valenzuela-Molina, F.; Adam, C.; Sánchez-Hidalgo, J.M.; Rufián-Peña, S.; Romero-Ruiz, A.; et al. Intraoperative metabolic changes associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Langenbecks Arch. Surg. 2024, 408, 34. [Google Scholar] [CrossRef]
  80. El-Sharkawy, F.; Sittig, M.; Nieroda, C.; Sardi, A. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of recurrent mucinous cystadenoma of the ovary. Eur. J. Gynaecol. Oncol. 2019, 40, 543–546. [Google Scholar]
  81. Samel, S.; Singal, A.; Becker, H.; Post, S. Problems with intraoperative hyperthermic peritoneal chemotherapy for advanced gastric cancer. Eur. J. Surg. Oncol. 2000, 26, 222–226. [Google Scholar] [CrossRef]
  82. Fagotti, A.; Ronsini, C.; Cianci, S.; Costantini, B.; Bernardini, F.; Corrado, G.; Vizzielli, G.; Scambia, G. Hipec at interval debulking surgery in advanced stage ovarian cancer patients: Impact of the ovhipec-1 trial in real life experience of a tertiary referral centre. Int. J. Gynecol. Cancer 2019, 29, A460. [Google Scholar]
  83. Santiago, N.L.; Han, E.S.; Raoof, M.; Wu, X.; Cho, H.; Lee, S.; Lin, W.-C.; Lin, J.F.-H.; Stewart, D.B.; Ruel, N.H.; et al. Cisplatin-induced nephrotoxicity in hyperthermic intraperitoneal chemotherapy (HIPEC) is mitigated by sodium thiosulfate: Clinical and toxicotranscriptomic results of a prospective trial. J. Clin. Oncol. 2022, 40, 16. [Google Scholar] [CrossRef]
  84. Feng, F.; Gao, Q.; Wu, Y.; Liu, C.; Yu, Y.; Li, B.; Chu, K.; Yi, B.; Cheng, Q.; Jiang, X. Cytoreductive surgery combined with hy-perthermic intraperitoneal chemotherapy vs. cytoreductive surgery alone for intrahepatic cholangiocarcinoma with peritoneal metastases: A retrospective cohort study. Eur. J. Surg. Oncol. 2021, 47, 2363–2368. [Google Scholar] [CrossRef]
  85. Somashekhar, S.P.; Prasanna, G.; Jaka, R.; Rauthan, A.; Murthy, H.S.; Karanth, S. Hyperthermic intraperitoneal chemotherapy for peritoneal surface malignancies: A single institution indian experience. Natl. Med. J. India 2016, 29, 262–266. [Google Scholar]
  86. Frankinet, L.; Bhatt, A.; Alcazer, V.; Classe, J.M.; Bereder, J.M.; Meeus, P.; Pomel, C.; Mithieux, F.; Abboud, K.; Wermert, R.; et al. Role of Hyperthermic Intraperitoneal Chemotherapy Combined with Cytoreductive Surgery as Consolidation Therapy for Advanced Epithelial Ovarian Cancer. Ann. Surg. Oncol. 2023, 30, 3287–3299. [Google Scholar] [CrossRef] [PubMed]
  87. Spiegelberg, J.; Neeff, H.; Holzner, P.; Runkel, M.; Fichtner-Feigl, S.; Glatz, T. Comparison of hyperthermic intraperitoneal chemotherapy regimens for treatment of peritoneal-metastasized colorectal cancer. World J. Gastrointest Oncol. 2020, 12, 903–917. [Google Scholar] [CrossRef] [PubMed]
  88. Giri, S.; Shah, S.H.; Batra Modi, K.; Rajappa, S.K.; Shukla, H.; Shrestha, E.; Jain, V.; Sekhon, R.; Rawal, S. Factors affecting peri-operative outcomes after CRS and HIPEC for advanced and recurrent ovarian cancer: A prospective single institutional study. J. Gynecol. Surg. 2017, 33, 4–11. [Google Scholar] [CrossRef]
  89. Stiles, Z.E.; Murphy, A.J.; Anghelescu, D.L.; Brown, C.L.; Davidoff, A.M.; Dickson, P.V.; Glazer, E.S.; Bishop, M.W.; Furman, W.L.; Pappo, A.S.; et al. Desmoplastic Small Round Cell Tumor: Long-Term Complications After Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy. Ann. Surg. Oncol. 2020, 27, 171–178. [Google Scholar] [CrossRef]
  90. Guerra-Londono, C.E.; Owusu-Agyemang, P.; Corrales, G.; Rofaeil, M.M.; Feng, L.; Fournier, K.; Cata, J.P. Risk of Intraoperative Hyperthermia and Outcomes in Adults Undergoing Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chem-otherapy (HIPEC). Ann. Surg. Oncol. 2022, 29, 2089–2099. [Google Scholar] [CrossRef] [PubMed]
  91. Sun, J.H.; Ji, Z.H.; Yu, Y.; Wu, H.T.; Huang, C.Q.; Zhang, Q.; Yang, X.-J.; Yonemura, Y.; Li, Y. Cytoreductive surgery plus hy-perthermic intraperitoneal chemotherapy to treat advanced/recurrent epithelial ovarian cancer: Results from a retrospective study on prospectively established database. Transl. Oncol. 2016, 9, 130–138. [Google Scholar] [CrossRef]
  92. Gupta, R.; Bhatnagar, S.; Gupta, N.; Garg, R.; Bharati, S.J.; Kumar, V.; Morris, D.L. The effect of perioperative fluid administration on outcomes of patients undergoing cytoreductive surgery with HIPEC: A retrospective study. Anesth. Analg. 2021, 133, 704–705. [Google Scholar]
  93. Tan, G.; Chia, C.; Kumar, M.; Choo, S.P.; Chia, J.; Tham, C.K.; Chua, C.; Soo, K.C.; Teo, M. 201 consecutive cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) procedures in a single Asian tertiary centre. Int. J. Hyperth. 2017, 33, 288–294. [Google Scholar] [CrossRef]
  94. Gupta, R.; Gupta, N.; Sirohiya, P.; Pandit, A.; Ratre, B.K.; Vig, S.; Bhan, S.; Singh, R.; Kumar, B.; Bhopale, S.; et al. Perioperative anaesthetic management in cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC): A retro-spective analysis in a single tertiary care cancer centre. Pleura Perit. 2022, 7, 127–134. [Google Scholar] [CrossRef]
  95. Tan, J.W.S.; Tan, G.H.C.; Ng, W.Y.; Ong, C.A.J.; Chia, C.S.; Soo, K.C.; Teo, M.C.C. High-grade complication is associated with poor overall survival after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Int. J. Clin. Oncol. 2020, 25, 984–994. [Google Scholar] [CrossRef] [PubMed]
  96. Harkawat, D.K. Study of anaesthetic implications in hyperthermic intraperitoneal chemotherapy: Observational study. Pravara Med. Rev. 2022, 14, 81–83. [Google Scholar]
  97. Tentes, A.A.K.; Palaskas, T.B.; Stamou, K.; Stoforos, C.E.; Pallas, N.; Karamveri, C.; Hristakis, C.; Kyriakopoulos, V. Cytore-ductive surgery combined with HIPEC in newly diagnosed and recurrent ovarian cancer. Eur. J. Gynaecol. Oncol. 2019, 40, 48–54. [Google Scholar]
  98. Hendrix, R.J.; Damle, A.; Williams, C.; Harris, A.; Spanakis, S.; Lambert, D.H.; Lambert, L.A. Restrictive Intraoperative Fluid Therapy is Associated with Decreased Morbidity and Length of Stay Following Hyperthermic Intraperitoneal Chemoperfusion. Ann. Surg. Oncol. 2019, 26, 490–496. [Google Scholar] [CrossRef] [PubMed]
  99. Vachez, E.; Bakrin, N.; Glehen, O. there is No Benefit for Preoperative Hyperhydratation before Cytoreductive Surgery and Hipec with Cisplatin when Combined with Sodium Thiosulfate. Int. J. Gynecol. Cancer 2022, 32, A287. [Google Scholar]
  100. Vogin, G.; Hettal, L.; Vignaud, J.M.; Dartigues, P.; Goere, D.; Ferron, G.; Heyd, B.; Bereder, J.-M.; Lherm, Y.; Villeneuve, L.; et al. Well-Differentiated Papillary Mesothelioma of the Peritoneum: A Retrospective Study from the RENAPE Observational Reg-istry. Ann. Surg. Oncol. 2019, 26, 852–860. [Google Scholar] [CrossRef]
  101. Hsieh, M.C.; Lu, C.Y.; Chang, W.W.; Wu, S.Y.; Hsiao, P.K.; Liu, T.J. Experiences with cytoreduction surgery plus hyperthermic intraperitoneal chemotherapy in Taiwan. Medicine 2017, 96, e7306. [Google Scholar] [CrossRef]
  102. Wallet, F.; Maucort Boulch, D.; Malfroy, S.; Ledochowski, S.; Bernet, C.; Kepenekian, V.; Passot, G.; Vassal, O.; Piriou, V.; Glehen, O.; et al. No impact on long-term survival of prolonged ICU stay and re-admission for patients undergoing cytoreductive surgery with HIPEC. Eur. J. Surg. Oncol. 2016, 42, 855–860. [Google Scholar] [CrossRef] [PubMed]
  103. Huang, S.W. Albumin replacement protects renal function in patient undergoing cytoreductive surgery and cisplatin-based hyperthermic intraperitoneal chemotherapy. Pleura Perit. 2023, 8, A38. [Google Scholar]
  104. Winicki, N.M.; Radomski, S.N.; Florissi, I.S.; Cloyd, J.M.; Gutta, G.; Grotz, T.E.; Scally, C.P.; Fournier, K.F.; Dineen, S.P.; Powers, B.D.; et al. Neighborhood-Level Socioeconomic Disadvantage Predicts Outcomes in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Malignancy. Ann. Surg. Oncol. 2023, 30, 7840–7847. [Google Scholar] [CrossRef]
  105. Jafari, M.D.; Halabi, W.J.; Stamos, M.J.; Nguyen, V.Q.; Carmichael, J.C.; Mills, S.D.; Pigazzi, A. Surgical outcomes of hyperthermic intraperitoneal chemotherapy: Analysis of the American College of Surgeons National Surgical Quality Improvement Program. JAMA Surg. 2014, 149, 170–175. [Google Scholar] [CrossRef]
  106. Wu, Y.; Zheng, X.; Sun, C.; Wang, S.; Ding, S.; Wu, M.; Zhang, J.; Wang, B.; Xue, L.; Yang, L.; et al. Hyperthermic intraperitoneal chemotherapy for patients with gastric cancer based on laboratory tests is safe: A single Chinese center analysis. BMC Surg. 2022, 22, 342. [Google Scholar] [CrossRef] [PubMed]
  107. Ji, Z.H.; Yu, Y.; Liu, G.; Zhang, Y.B.; An, S.L.; Li, B.; Li, X.-B.; Yan, G.-J.; Li, Y. Peritoneal cancer index (PCI) based patient selecting strategy for complete cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy in gastric cancer with peritoneal metastasis: A single-center retrospective analysis of 125 patients. Eur. J. Surg. Oncol. 2021, 47, 1411–1419. [Google Scholar] [CrossRef]
  108. Ye, J.; Ren, Y.; Wei, Z.; Peng, J.; Chen, C.; Song, W.; Tan, M.; He, Y.; Yuan, Y. Nephrotoxicity and long-term survival investigations for patients with peritoneal carcinomatosis using hyperthermic intraperitoneal chemotherapy with cisplatin: A retrospective cohort study. Surg. Oncol. 2018, 27, 456–461. [Google Scholar] [CrossRef] [PubMed]
  109. Kajdi, M.E.; Beck-Schimmer, B.; Held, U.; Kofmehl, R.; Lehmann, K.; Ganter, M.T. Anaesthesia in patients undergoing cytore-ductive surgery with hyperthermic intraperitoneal chemotherapy: Retrospective analysis of a single centre three-year expe-rience. World J. Surg. Oncol. 2014, 12, 136. [Google Scholar] [CrossRef]
  110. Zaballos, M.; Power, M.; Canal-Alonso, M.I.; González-Nicolás, M.Á.; Vasquez-Jimenez, W.; Lozano-Lominchar, P.; Cabrerizo-Torrente, P.; Palencia-García, N.; Gago-Quiroga, S.; Ginel-Feito, M.D.; et al. Effect of Cilastatin on Cisplatin-Induced Nephrotoxicity in Patients Undergoing Hyperthermic Intraperitoneal Chemotherapy. Int. J. Mol. Sci. 2021, 22, 1239. [Google Scholar] [CrossRef]
  111. Kepenekian, V.; Péron, J.; Goéré, D.; Sgarbura, O.; Delhorme, J.B.; Eveno, C.; Benzerdjeb, N.; Bonnefoy, I.; Villeneuve, L.; Rousset, P.; et al. Multicystic peritoneal mesothelioma treated with cytoreductive surgery followed or not by hyperthermic intraperi-toneal chemotherapy: Results from a large multicentric cohort. Int. J. Hyperth. 2021, 38, 805–814. [Google Scholar] [CrossRef]
  112. Zhang, J.; Li, X.B.; Ji, Z.H.; Ma, R.; Bai, W.P.; Li, Y. Cytoreductive Surgery plus Hyperthermic Intraperitoneal Chemotherapy Improves Survival with Acceptable Safety for Advanced Ovarian Cancer: A Clinical Study of 100 Patients. BioMed Res. Int. 2021, 2021. [Google Scholar]
  113. Khatun, R.; Shen, C.; Pameijer, C.; Peng, J.S. Predictors of Renal Complication after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Analysis of the NSQIP Database. J. Am. Coll. Surg. 2021, 233, e184. [Google Scholar] [CrossRef]
  114. Zhou, S.; Feng, Q.; Zhang, J.; Zhou, H.; Jiang, Z.; Liu, Z.; Zheng, Z.; Chen, H.; Wang, Z.; Liang, J.; et al. High-grade postoperative complications affect survival outcomes of patients with colorectal Cancer peritoneal metastases treated with Cytoreductive surgery and Hyperthermic Intraperitoneal chemotherapy. BMC Cancer 2021, 21, 41. [Google Scholar] [CrossRef] [PubMed]
  115. Kianmanesh, R.; Scaringi, S.; Sabate, J.M.; Castel, B.; Pons-Kerjean, N.; Coffin, B.; Hay, J.-M.; Flamant, Y.; Msika, S. Iterative cytoreductive surgery associated with hyperthermic intraperitoneal chemotherapy for treatment of peritoneal carcinomatosis of colorectal origin with or without liver metastases. Ann. Surg. 2007, 245, 597–603. [Google Scholar] [CrossRef] [PubMed]
  116. Zivanovic, O.; Abramian, A.; Kullmann, M.; Fuhrmann, C.; Coch, C.; Hoeller, T.; Ruehs, H.; Keyver-Paik, M.D.; Rudlowski, C.; Weber, S.; et al. HIPEC ROC I: A phase i study of cisplatin administered as hyperthermic intraoperative intraperitoneal chemoperfusion followed by postoperative intravenous platinum-based chemotherapy in patients with platinum-sensitive recurrent epithelial ovarian cancer. Int. J. Cancer 2015, 136, 699–708. [Google Scholar] [CrossRef] [PubMed]
  117. Liesenfeld, L.F.; Quiring, E.; Al-Saeedi, M.; Nusshag, C.; Büchler, M.W.; Schneider, M. Extensive Peritonectomy Is an Independent Risk Factor for Cisplatin HIPEC-Induced Acute Kidney Injury. Ann. Surg. Oncol. 2022, 30, 2646–2656. [Google Scholar] [CrossRef] [PubMed]
  118. Somashekhar, S.; Yethadka, R.; Kumar, R.; Ashwin, K.; Zaveri, S.; Rauthan, A. Toxicity Profile of Chemotherapy Agents Used in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Surface Malignancies. Eur. J. Surg. Oncol. 2020, 46, 577–581. [Google Scholar] [CrossRef] [PubMed]
  119. Lim, M.C.; Chang, S.-J.; Park, B.; Yoo, H.J.; Yoo, C.W.; Nam, B.H.; Park, S.-Y.; HIPEC for Ovarian Cancer Collaborators. Survival after Hyperthermic Intraperitoneal Chemotherapy and Primary or Interval Cytoreductive Surgery in Ovarian Cancer: A Randomized Clinical Trial. JAMA Surg. 2022, 157, 374–383. [Google Scholar] [CrossRef] [PubMed]
  120. Senguttuvan, R.N.; Santiago, N.L.; Han, E.S.; Lee, B.; Lee, S.; Lin, W.-C.; Kebria, M.; Hakim, A.; Lin, J.F.; Wakabayashi, M.T.; et al. Impact of Sodium Thiosulfate on Prevention of Nephrotoxicities in HIPEC: An Ancillary Evaluation of Cisplatin-Induced Toxicities in Ovarian Cancer. Ann. Surg. Oncol. 2023, 30, 8144–8155. [Google Scholar] [CrossRef]
  121. Glennon, K.; Mulligan, K.; Carpenter, K.; Mooney, R.; Mulsow, J.; McCormack, O.; Boyd, W.; Walsh, T.; McVey, R.; Thompson, C.; et al. The Addition of Sodium Thiosulphate to Hyperthermic Intraperitoneal Chemotherapy with Cisplatin in Ovarian Cancer. Gynecol. Oncol. Rep. 2021, 37, 100796. [Google Scholar] [CrossRef]
  122. Angeles, M.A.; Quenet, F.; Vieille, P.; Gladieff, L.; Ruiz, J.; Picard, M.; Migliorelli, F.; Chaltiel, L.; Martínez-Gómez, C.; Martinez, A.; et al. Predictive Risk Factors of Acute Kidney Injury after Cytoreductive Surgery and Cisplatin-Based Hyperthermic Intra-Peritoneal Chemotherapy for Ovarian Peritoneal Carcinomatosis. Int. J. Gynecol. Cancer 2019, 29, 382–391. [Google Scholar] [CrossRef] [PubMed]
  123. Lim, S.J.; Cormier, J.N.; Feig, B.W.; Mansfield, P.F.; Benjamin, R.S.; Griffin, J.R.; Chase, J.L.; Pisters, P.W.T.; Pollock, R.E.; Hunt, K.K. Toxicity and Outcomes Associated with Surgical Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Patients with Sarcomatosis. Ann. Surg. Oncol. 2007, 14, 2309–2318. [Google Scholar] [CrossRef] [PubMed]
  124. Nizri, E.; Baratti, D.; Guaglio, M.; Sinukumar, S.; Cabras, A.; Kusamura, S.; Deraco, M. Multicystic Mesothelioma: Operative and Long-Term Outcomes with Cytoreductive Surgery and Hyperthermic Intra Peritoneal Chemotherapy. Eur. J. Surg. Oncol. 2018, 44, 1100–1104. [Google Scholar] [CrossRef] [PubMed]
  125. Sin, E.I.-L.; Chia, C.S.; Tan, G.H.C.; Soo, K.C.; Teo, M.C.-C. Acute Kidney Injury in Ovarian Cancer Patients Undergoing Cytoreductive Surgery and Hyperthermic Intra-Peritoneal Chemotherapy. Int. J. Hyperth. 2017, 33, 690–695. [Google Scholar] [CrossRef] [PubMed]
  126. Tan, G.H.C.; Shannon, N.B.; Chia, C.S.; Soo, K.C.; Teo, M.C.C. Platinum Agents and Mitomycin C-Specific Complications in Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Int. J. Hyperth. 2017, 34, 595–600. [Google Scholar] [CrossRef] [PubMed]
  127. Warschkow, R.; Tarantino, I.; Lange, J.; Müller, S.A.; Schmied, B.M.; Zünd, M.; Steffen, T. Does Hyperthermic Intraoperative Chemotherapy Lead to Improved Outcomes in Patients with Ovarian Cancer? A Single Center Cohort Study in 111 Consecutive Patients. Patient Saf. Surg. 2012, 6, 12. [Google Scholar] [CrossRef] [PubMed]
  128. Cata, J.P.; Zavala, A.M.; Van Meter, A.; Williams, U.U.; Soliz, J.; Hernandez, M.; Owusu-Agyemang, P. Identification of Risk Factors Associated with Postoperative Acute Kidney Injury after Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy: A Retrospective Study. Int. J. Hyperth. 2017, 34, 538–544. [Google Scholar] [CrossRef] [PubMed]
  129. Chan, C.-Y.; Li, H.; Wu, M.-F.; Liu, C.-H.; Lu, H.-W.; Lin, Z.-Q.; Li, J. A Dose-Finding Trial for Hyperthermic Intraperitoneal Cisplatin in Gynecological Cancer Patients Receiving Hyperthermic Intraperitoneal Chemotherapy. Front. Oncol. 2021, 11, 616264. [Google Scholar] [CrossRef] [PubMed]
  130. Friedrich, M.; Zinn, W.; Kolnsberg, L.; Kraft, C.; Kuhn, W. Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Ovarian Cancer: Evaluation of Side Effects in a Single Institution Cohort. Anticancer. Res. 2020, 40, 1481–1486. [Google Scholar] [CrossRef]
  131. D’hondt, V.; Goffin, F.; Roca, L.; Dresse, D.; Leroy, C.; Kerger, J.; Cordier, L.; de Forges, H.; Veys, I.; Liberale, G. Interval Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in First-Line Treatment for Advanced Ovarian Carcinoma: A Feasibility Study. Int. J. Gynecol. Cancer 2016, 26, 912–917. [Google Scholar] [CrossRef]
  132. Rihuete Caro, C.; Manzanedo, I.; Pereira, F.; Carrion-Alvarez, L.; Serrano, Á.; Pérez-Viejo, E. Cytoreductive Surgery Combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Patients with Gastric Cancer and Peritoneal Carcinomatosis. Eur. J. Surg. Oncol. 2018, 44, 1805–1810. [Google Scholar] [CrossRef]
  133. Chatzigeorgiou, K. Treatment of Recurrent Epithelial Ovarian Cancer with Secondary Cytoreduction and Continuous Intraoperative Intraperitoneal Hyperthermic Chemoperfusion (CIIPHCP). Zentralblatt Für Gynäkologie 2003, 125, 424–429. [Google Scholar] [CrossRef] [PubMed]
  134. Raj, H.; Keerthi, M.S.S.; Palaniappan, R.; Prakash, U.; Dhanushkodi, M.; Ganesan, T.S. Phase 2 Non-Randomised Trial of Secondary Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy in Recurrent Platinum-Sensitive Ovarian Cancer. Ecancermedicalscience 2021, 15, 1260. [Google Scholar] [CrossRef] [PubMed]
  135. Bondar, O.V.; Chetverikov, S.H.; Maksymovskyi, V.Y.; Atanasov, D.V.; Chetverikova-Ovchynnyk, V.V.; Chetverikov, M.S. The Impact of Hyperthermic Intraperitoneal Chemotherapy and Cytoreductive Surgery on Clinical Outcomes and Quality of Life of Patients with Peritoneal Carcinomatosis. Contemp. Oncol. 2021, 25, 270–278. [Google Scholar] [CrossRef]
  136. Carias, E.; Ferreira, H.; Chuva, T.; Paiva, A.; Maximino, J. Acute Kidney Injury after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in a Portuguese Population. World J. Oncol. 2022, 13, 370–378. [Google Scholar] [CrossRef] [PubMed]
  137. Bai, Y.; Du, Y.; Ye, P.; Luo, Y. Acute Kidney Injury after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Patients with Advanced Ovarian Cancer. Front. Oncol. 2023, 13, 1094410. [Google Scholar] [CrossRef] [PubMed]
  138. Gómez-Ruiz, Á.J.; González-Gil, A.; Gil, J.; Alconchel, F.; Navarro-Barrios, Á.; Gil-Gómez, E.; Martínez, J.; Nieto, A.; García-Palenciano, C.; Cascales-Campos, P.A. Acute Renal Disease in Patients with Ovarian Peritoneal Carcinomatosis Treated with Cytoreduction and HIPEC: The Influence of Surgery and the Cytostatic Agent Used. Langenbeck’s Arch. Surg. 2021, 406, 2449–2456. [Google Scholar] [CrossRef] [PubMed]
  139. Hakeam, H.A.; Breakiet, M.; Azzam, A.; Nadeem, A.; Amin, T. The Incidence of Cisplatin Nephrotoxicity Post Hyperthermic Intraperitoneal Chemotherapy (HIPEC) and Cytoreductive Surgery. Ren. Fail. 2014, 36, 1486–1491. [Google Scholar] [CrossRef] [PubMed]
  140. Bhatt, A.; Glehen, O.; Zivanovic, O.; Brennan, D.; Nadeau, C.; Van Driel, W.; Bakrin, N. The 2022 PSOGI International Consensus on HIPEC Regimens for Peritoneal Malignancies: Epithelial Ovarian Cancer. Ann. Surg. Oncol. 2023, 30, 8115–8137. [Google Scholar] [CrossRef]
  141. Vachez, E.; Kefleyesus, A.; Bakrin, N.; Ranchon, F.; Rioufol, C.; Vassal, O.; Al-Hadeedi, O.; Kepenekian, V.; Glehen, O. Eliminating the Need for Preoperative Intravenous Hyperhydration: Sodium Thiosulfate as Nephrotoxicity Prevention in HIPEC-Treated Patients—A Retrospective Analysis. Eur. J. Surg. Oncol. 2024, 50, 107955. [Google Scholar] [CrossRef]
  142. Yaqub, S.; Hashmi, S.; Kazmi, M.K.; Aziz Ali, A.; Dawood, T.; Sharif, H. A Comparison of AKIN, KDIGO, and RIFLE Definitions to Diagnose Acute Kidney Injury and Predict the Outcomes after Cardiac Surgery in a South Asian Cohort. Cardiorenal Med. 2022, 12, 29–38. [Google Scholar] [CrossRef] [PubMed]
  143. Erdost, H.; Ozkardesler, S.; Akan, M.; Iyilikci, L.; Unek, T.; Ocmen, E.; Dalak, R.; Astarcioglu, I. Comparison of the RIFLE, AKIN, and KDIGO Diagnostic Classifications for Acute Renal Injury in Patients Undergoing Liver Transplantation. Transplant. Proc. 2016, 48, 2112–2118. [Google Scholar] [CrossRef] [PubMed]
  144. Younan, R.; Kusamura, S.; Baratti, D.; Cloutier, A.; Deraco, M. Morbidity, Toxicity, and Mortality Classification Systems in the Local Regional Treatment of Peritoneal Surface Malignancy. J. Surg. Oncol. 2008, 98, 253–257. [Google Scholar] [CrossRef] [PubMed]
Jcm 13 03793 g001
Figure 1. PRISMA diagram [12].
Figure 1. PRISMA diagram [12].
Jcm 13 03793 g001
Jcm 13 03793 g002
Figure 2. (A) One-arm forest plot of acute kidney injury (AKI) incidence after the use of HIPEC in carcinomatosis patients. (B) AKI incidence true effects distribution (predictive interval).
Figure 2. (A) One-arm forest plot of acute kidney injury (AKI) incidence after the use of HIPEC in carcinomatosis patients. (B) AKI incidence true effects distribution (predictive interval).
Jcm 13 03793 g002
Jcm 13 03793 g003
Figure 3. (A) Forest plot of chronic kidney disease (CKD) incidence after the use of HIPEC in PSM patients. (B) CKD incidence true effects distribution (predictive interval).
Figure 3. (A) Forest plot of chronic kidney disease (CKD) incidence after the use of HIPEC in PSM patients. (B) CKD incidence true effects distribution (predictive interval).
Jcm 13 03793 g003
Jcm 13 03793 g004
Figure 4. Forest plot of AKI incidence depending on the scale used.
Figure 4. Forest plot of AKI incidence depending on the scale used.
Jcm 13 03793 g004
Jcm 13 03793 g005
Figure 5. Forest plot of post cisplatin-based HIPEC AKI incidence in patients with previous CKD.
Figure 5. Forest plot of post cisplatin-based HIPEC AKI incidence in patients with previous CKD.
Jcm 13 03793 g005
Jcm 13 03793 g006
Figure 6. Forest plot of overall AKI incidence with or without nephroprotection (one-arm studies).
Figure 6. Forest plot of overall AKI incidence with or without nephroprotection (one-arm studies).
Jcm 13 03793 g006
Jcm 13 03793 g007
Figure 7. Incidence of AKI in 2-arm studies comparing the use versus non-use of nephroprotectors.
Figure 7. Incidence of AKI in 2-arm studies comparing the use versus non-use of nephroprotectors.
Jcm 13 03793 g007
Jcm 13 03793 g008
Figure 8. Graphical representation of acute renal impairment scales. Green: RIFLE scale; orange: AKIN scale; blue: CTCAE scale. Arrows: renal replacement therapy.
Figure 8. Graphical representation of acute renal impairment scales. Green: RIFLE scale; orange: AKIN scale; blue: CTCAE scale. Arrows: renal replacement therapy.
Jcm 13 03793 g008
Table 1. Extracted variables.
Table 1. Extracted variables.
Study characteristicsType of study: observational studies, either prospective or retrospective, randomized and non-randomized clinical trials.
Unicentric or multicentric.
Year of publication.
PopulationNumber of patients included.
Number of study arms and their distribution based on HIPEC protocol and nephroprotective usage.
Gender distribution: male or female.
Age.
Previous chronic renal disease (yes/no).
Previous chemotherapy: cisplatin, other drugs, non-stated.
Renal injury predisposing factors: ACE * inhibitors and angiotensin II receptor inhibitors, diabetes, hypertension.
Etiology of PSM: ovarian or other.
HIPECHIPEC drugs: cisplatin or cisplatin + doxorubicin.
Perfusate volume: fixed volumes or body surface area-based volume.
Dosage: ≤50 mg/m2; 50–75 mg/m2; 75–100 mg/m2; ≥100 mg/m2.
Duration (minutes).
Temperature (Celsius).
Open or closed technique.
Nephroprotective strategy: sodium thiosulphate (ST), amifostine, no.
Kidney injuryIncidence of acute kidney injury.
Acute kidney injury classification: RIFLE, KDIGO, AKIN, WHO, Clavien–Dindo, CTCAE.
Incidence of chronic kidney disease.
* ACE inhibitors: angiotensin-converting enzyme (ACE) inhibitors.
Table 2. Characteristics of included studies.
Table 2. Characteristics of included studies.
StudyCountryStudy DesignTreatmentNephroprotectorSample SizeCases of Renal ImpairmentPrevious CKDTumor EtiologyCisplatin DoseHIPEC Duration (Minutes)Renal Impairment Scale
Martina 2019 [122]FranceCohortCisplatinNo6630NoOvary50–100 mg/m260 minRIFLE
Laplace 2020T [6]FranceCohortCisplatinYes (ST)7311YesVarious50–100 mg/m260–90 minWHO
Lim 2007 [123] USANon-randomized clinical trialCisplatinYes (amifostine)197NoVarious90 mg/m2 *90 minCTCAE
Nizri 2018 [124]ItalyCohortCisplatin and doxorubicinNo192N/AN/A42.5 mg/L + 15.2 mg/L **90 minCTCAE
Sin 2017 [125]SingaporeCohortCisplatinNo4719N/AOvary90 mg/m260 minCTCAE
Somashekhar 2019T [118]IndiaCohortBothNo1147N/AVarious75–100 mg/m2 #
40 + 15 mg/m2 **		90 minCTCAE
Tan 2017 [126]SingaporeCohortCisplatinNo9232NoVarious40 mg/body surface60 minCTCAE
Warschkow 2012 [127]SwitzerlandCohortCisplatinNo212YesOvary50 mg/m2 $90 minN/A
Cata 2018 [128]USACohortCisplatinNo8129NoN/ANot-statedN/AAKIN
Chan 2021 [129]ChinaNon-randomized clinical trialCisplatinNo307N/AVarious70 mg/m2, 75 mg/m2, 80 mg/m2 and 85 mg/m2 &60 minCTCAE
Friedrich 2020 [130]GermanyCase seriesCisplatinNo422N/AOvary50 mg/m290 minCLAVIEN DINDO
Alonso 2022 [7]AustraliaCase-controlCisplatinYes (ST)104NoVarious100 mg/m2 %90 minRIFLE
D’Hondt 2016 [131]BelgiumNon-randomized clinical trialCisplatinNo161NoOvary50 mg/m260 minCTCAE
Liesenfeld 2023 T [117]GermanyCohortBothNo5637N/AVarious75 mg/m2 %
50 mg/m2 + 15 mg/m2 **
50 mg/m2 + 15 mg/m2 ** + EPIC		90 minKDIGO
Rihuete-Caro 2018 [132]SpainCohortCisplatin and adriamicineNo351N/AN/A100 mg/m2 + 15 mg/m2 **90 minRIFLE
Chatzigeorgiou 2003 [133]GreeceNon-randomized clinical trialCisplatinYes (amifostine)202N/AOvary50–70 mg/m2 #120 minCTCAE
Lim 2022 T [119]South KoreaRandomized clinical trialCisplatinYes (amifostine)9221N/AOvary75 mg/m290 minCTCAE
Glennon 2021 T [121]IrelandCase-controlCisplatinYes (ST)301NoOvary50 mg/m2
100 mg/m2		90 minKDIGO
Raj 2021 [134]IndiaNon-randomized clinical trialCisplatinNo150N/AOvary75 mg/m260 minCLAVIEN DINDO
Bondar 2021 [135]UkraineCohortCisplatin and adriamicineYes (ST)578N/AVarious50 mg/m2 + 15 mg/m2 **90 minCLAVIEN DINDO
Carias 2022 [136]PortugalCohortCisplatinNo4211N/AVarious50 mg/m290 minKDIGO
Bai 2023 [137]ChinaCohortCisplatinNo28233N/AOvary50 to 80 mg/m260 minKDIGO
Senguttuvan 2023 T [120]USANon-randomized clinical trialCisplatinYes (ST)406N/AVarious75 mg/m260 minCTCAE
Chen 2021 [58]AustraliaCohortCisplatinNo594N/AVarious100 mg/m2 %90 minRIFLE
Gomez-Ruiz 2021 [138]SpainCohortCisplatinNo6214N/AOvary75 mg/m260 minRIFLE
Hakeam 2014 [139]Saudi ArabiaCohortCisplatin and adriamicineNo532YesVarious50 mg/m2 + 15 mg/m2 **90 minRIFLE
ST: sodium thiosulphate; N/A: not available; CKD: chronic kidney disease; * 1 patient received 150 mg/m2, 1 patient received 120 mg/m2; ** Cisplatin + doxorubicin; # Range dose; $ 10 patients received a 30% reduction; & Dose finding trial; % 25% dose reduction if previous CKD, previous chemotherapy with 2 different drugs or previous HIPEC.
Table 3. (A) Risk of bias assessed by the Joanna Briggs Institute (JBI) Critical Appraisal Tools for use in cohort studies [26]. (B) Risk of bias assessed by the JBI Critical Appraisal Tools for use in case-control studies [26]. (C) Risk of bias assessed by the JBI Critical Appraisal Tools for use in case series studies [25]. (D) Risk of bias assessed by the JBI Critical Appraisal Tools for use in randomized clinical trials [24]. (E) Risk of bias assessed by the JBI Critical Appraisal Tools for use in non-randomized clinical trials [24].
Table 3. (A) Risk of bias assessed by the Joanna Briggs Institute (JBI) Critical Appraisal Tools for use in cohort studies [26]. (B) Risk of bias assessed by the JBI Critical Appraisal Tools for use in case-control studies [26]. (C) Risk of bias assessed by the JBI Critical Appraisal Tools for use in case series studies [25]. (D) Risk of bias assessed by the JBI Critical Appraisal Tools for use in randomized clinical trials [24]. (E) Risk of bias assessed by the JBI Critical Appraisal Tools for use in non-randomized clinical trials [24].
(A)
StudyJBc1JBc2JBc3JBc4JBc5JBc6JBc7JBc8JBc9JBc10JBc11% YesRisk
Martina 2019 [122]✓✓✓✓✓✓✓✓✓✓✓100Low
Laplace 2020 [6]✓✓✓✓✓✓✓✓✓✓--91Low
Nizri 2018 [124]✓✓✓✓✓✓✓✓✓✓✓100Low
Sin 2017 [125]✓✓✓✓✓✓✓✓✓✓✓100Low
Somashekhar 2019 [118]✓✓✓✓✓✓✓✓✓✓--91Low
Tan 2017 [126]✓✓✓✓✓✓✓✓✓✓✓100Low
Warschkow 2012 [127]✓✓✓✓✓✓U✓✓✓✓91Low
Cata 2018 [129]✓✓✓✓✓✓✓✓✓U✓91Low
Liesenfeld 2023 [117]✓✓✓✓✓✓✓✓✓✓✓100Low
Rihuete-Caro 2018 [132]✓✓✓✓✓✓U✓✓✓✓91Low
Bondar 2021 [135]✓✓✓✓✓✓✓✓✓✓✓100Low
Carias 2022 [136]✓✓✓✓✓✓✓✓✓✓✓100Low
Bai 2023 [137]✓✓✓✓✓✓✓✓UU✓82Low
Chen 2021 [58]✓✓✓✓✓✓✓✓UU✓82Low
Gomez-Ruiz 2021 [138]✓✓✓✓✓✓✓✓✓✓✓100Low
Hakeam 2014 [139]✓✓✓✓✓✓✓✓UU✓82Low
(B)
StudyJBcc1JBcc2JBcc3JBcc4JBcc5JBcc6JBcc7JBcc8JBcc9JBcc10% YesRisk
Alonso 2022 [7]✓✓✓✓✓----✓✓--70Low
Glennon 2021 [123]✓✓✓✓✓✓✓✓✓--90Low
(C)
StudyJBcs1JBcs2JBcs3JBcs4JBcs5JBcs6JBcs7JBcs8JBcs9JBcs10% YesRisk
Friedrich 2020 [130]✓✓✓✓✓✓✓✓✓✓100Low
(D)
StudyJBrct1JBrct2JBrct3JBrct4JBrct5JBrct6JBrct7JBrct8JBrct9JBrct10JBrct11JBrct12JBrct13% YesRisk
Lim 2022 [119]✓✓✓✓--U✓✓✓✓✓✓✓85Low
(E)
StudyJBnrct1JBnrct2JBnrct3JBnrct4JBnrct5JBnrct6JBnrct7JBnrct8JBnrct9% YesRisk
Lim 2007 [123]✓✓✓✓✓✓✓✓--89Low
Chan 2021 [129]✓✓✓--✓✓✓✓✓89Low
D’Hondt 2016 [131]✓✓✓----✓✓✓--67Moderate
Chatzigeorgiou 2003 [133]✓UU--✓✓✓✓✓67Moderate
Raj 2021 [134]✓UU--✓✓✓✓✓67Moderate
Senguttuvan 2023 [120]--✓--✓✓✓✓✓✓78Low
Gouy 2016 [27]✓✓✓----✓✓✓✓78Low
(A) Notes: ✓: Yes; --: No; U: Unclear; Quality items JBc1: Were the two groups similar and recruited from the same population? JBc2: Were the exposures measured similarly to assign people to both the exposed and unexposed groups? JBc3: Was the exposure measured in a valid and reliable way? JBc4: Were confounding factors identified? JBc5: Were strategies to deal with confounding factors stated? JBc6: Were the groups/participants free of the outcome at the start of the study (or at the moment of exposure)? JBc7: Were the outcomes measured in a valid and reliable way? JBc8: Was the follow-up time reported and sufficient to be long enough for outcomes to occur? JBc9: Was follow-up complete and, if not, were the reasons for loss of follow-up described and explored? JBc10: Were strategies to address incomplete follow-up utilized? JBc11: Was appropriate statistical analysis used? (B) Notes: ✓: Yes; --: No; U: Unclear; Quality items JBcc1: Were the groups comparable other than the presence of disease in cases or the absence of disease in controls? JBcc2: Were cases and controls matched appropriately? JBcc3: Were the same criteria used for the identification of cases and controls? JBcc4: Was exposure measured in a standard, valid, and reliable way? JBcc5: Was exposure measured in the same way for cases and controls? JBcc6: Were confounding factors identified? JBcc7: Were strategies to deal with confounding factors stated? JBcc8: Were outcomes assessed in a standard, valid, and reliable way for cases and controls? JBcc9: Was the exposure period of interest long enough to be meaningful? JBcc10: Was appropriate statistical analysis used? (C) Notes: ✓: Yes; --: No; U: Unclear; Quality items JBcs1: Were there clear criteria for inclusion in the case series? JBcs2: Was the condition measured in a standard, reliable way for all participants included in the case series? JBcs3: Were valid methods used for the identification of the condition for all participants included in the case series? JBcs4: Did the case series have consecutive inclusion of participants? JBcs5: Did the case series have complete inclusion of participants? JBcs6: Was there clear reporting of the demographics of the participants in the study? JBcs7: Was there clear reporting of the clinical information of the participants? JBcs8: Were the outcomes or follow-up results of cases clearly reported? JBcs9: Was there clear reporting of the presenting site(s)/clinic(s)’ demographic information? JBcs10: Was appropriate statistical analysis used? (D) Notes: ✓: Yes; --: No; U: Unclear; Quality items JBrct1: Was true randomization used for the assignment of participants to treatment groups? JBrct2: Was allocation to treatment groups concealed? JBrct3: Were treatment groups similar at the baseline? JBrct4: Were participants blind to treatment assignment? JBrct5: Were those delivering treatment blind to treatment assignment? JBrct6: Were outcomes assessors blind to treatment assignment? JBrct7: Were treatment groups treated identically other than the intervention of interest? JBrct8: Was follow-up complete and, if not, were differences between groups in terms of their follow-up adequately described and analyzed? JBrct9: Were participants analyzed in the groups to which they were randomized? JBrct10: Were outcomes measured in the same way for treatment groups? JBrct11: Were outcomes measured in a reliable way? JBrct12: Was appropriate statistical analysis used? JBrct13: Was the trial design appropriate, and any deviations from the standard RCT design (individual randomization, parallel groups) accounted for in the conduct and analysis of the trial? (E) Notes: ✓: Yes; --: No; U: Unclear; Quality items JBnrct1: Is it clear in the study what is the ‘cause’ and what is the ‘effect’ (i.e., there is no confusion about which variable comes first)? JBnrct2: Were the participants included in any comparisons similar? JBnrct3: Were the participants included in any comparisons receiving similar treatment/care, other than the exposure or intervention of interest? JBnrct4: Was there a control group? JBnrct5: Were there multiple measurements of the outcome both pre and post the intervention/exposure? JBnrct6: Was follow-up complete and, if not, were differences between groups in terms of their follow-up adequately described and analyzed? JBnrct7: Were the outcomes of participants included in any comparisons measured in the same way? JBnrct8: Were outcomes measured in a reliable way? JBnrct9: Was appropriate statistical analysis used?
Table 4. Main overall results and subgroup analysis of possible variables involved in AKI incidence.
Table 4. Main overall results and subgroup analysis of possible variables involved in AKI incidence.
Subgroup by Study CharacteristicsNº of StudiesParticipantsEffect Size and 95% Interval *Heterogeneity I2p Value
AKI IncidenceLower LimitUpper Limit
1473
Nephroprotector 1 0.194
Yes820811.5%4.9%25,0%65.0%
No24126520.5%14.5%28.0%84.8%
Nephroprotector 2 0.362
Amifostine36014.0%2.9%46.9%71.2%
Sodium thiosulphate51488.8%2.5%27.0%65.8%
No nephroprotector24126520.5%14.5%28.0%84.8%
HIPEC 0.432
Cisplatin26126120.2%14.6%27,2%81.3%
Cisplatin and adriamicine621212.5%3.5%36.0%87.7%
Cisplatin dose 0.411
≤50 mg/m2624312.5%6.8%2.8%75.3%
>50–75 mg/m2230211.6%8.4%15.7%0.0%
75–100 mg/m21351918.8%11.7%28.9%77.0%
≥100 mg/m2516512.9%4.1%33.7%79.5%
HIPEC duration 0.465
60 min1065023.2%14.4%35.0%84.40%
60–90 min2739.1%0.3%76.1%83.0%
90 min1864915.2%8.7%25.3%83.7%
120 min12010.0%2.5%32.4%0.0%
Renal impairment scale 0.005
AKIN18135.8%26.1%46.8%0.0%
CLAVIEN DINDO31148.8%3.6%20%32.1%
CTCAE1549917.8%11.6%26.3%70.4%
KDIGO438038.8%13.1%72.7%95.3%
RIFLE628515.4%6.1%33.8%86.8%
WHO2739.1%0.4%76.1%83%
Tumor origin 0.358
Ovary1369315.5%9.2%25.1%82.0%
Various1664521.3%13.3532.4%83.8%
Previous kidney disease 0.036
No831433.9%25.3%43.6%47.9%
Yes41478.4%1.9%30.2%79.6%
Sex distribution (Woman %) 0.259
≤50%311126.8%12.9%47.6%56.2%
50–75%519030.2%11.4%59.4%90.0%
>75%2197716.0%10.7%23.1%79.5%
Age distribution 0.268
≤60 years1964118.0%12.3%25.6%71.3%
>60 years642131.4%11.9%61.0%93%
Table 5. AKI classification scales.
Table 5. AKI classification scales.
ScaleCreatinine CriteriaUrine Output Criteria
RIFLE
R (Risk)Serum creatinine increase 1.5-fold or GFR > 25% from baseline<0.5 mL/kg/h for 6 h
I (Injury)Serum creatinine increase 2.0-fold or GFR > 50% from baseline<0.5 mL/kg/h for 12 h
F (Failure)Serum creatinine increase 3.0-fold or GFR > 75% from baseline or serum creatinine > 4.0 mg/dL with an acute increase of at least 0.5 mg/dLAnuria for 12 h
AKIN
1Serum creatinine increase 0.3 mg/dL or increase to 1.5–2.0 fold from baseline<0.5 mL/kg/h for 6 h
2Serum creatinine increase > 2.0–3.0 fold from baseline<0.5 mL/kg/h for 12 h
3Serum creatinine increase > 3.0 fold from baseline or serum creatinine ≥ 4.0 mg/dL with an acute increase of at least 0.5 mg/dL or need for renal replacement therapy<0.3 mL/kg/h for 24 h or anuria for 12 h or need for renal replacement therapy
KDIGO
1Serum creatinine increase 1.5–1.9 times baseline or ≥0.3 mg/dL within 48 h<0.5 mL/kg/h for 6–12 h
2Serum creatinine increase 2.0–2.9 times baseline<0.5 mL/kg/h for ≥12 h
3Serum creatinine increase 3.0 mg/dL times baseline or increase ≥ 4.0 mg/dL or initiation of renal replacement therapy <0.3 mL/kg/h for 24 h or anuria for ≥12 h
CTCAE v. 5.0. (Acute kidney injury)
Grade 1--
Grade 2--
Grade 3Hospitalization indicated-
Grade 4Life-threatening consequences; dialysis indicated-
CTCAE (Creatinine increase)
Grade 1Creatinine increased > upper limit normal (ULN)-1.5 × ULN -
Grade 2Creatinine increased > 1.5–3.0 × baseline; >1.5–3.0 × ULN-
Grade 3Creatinine increased > 3.0 × baseline; 3.0–6.0 × ULN -
Grade 4Creatinine increased > 6.0 × ULN-
Clavien–Dindo
Grade IAny deviation from the normal postoperative course without the need for pharmacological treatment, or surgical, endoscopic, and radiological interventions
Allowed therapeutic regimens are drugs including antiemetics, antipyretics, analgesics, and diuretics and electrolytes, and physiotherapy. This grade also includes wound infections opened at the bedside		-
Grade IIRequiring pharmacological treatment with drugs other than such allowed for grade I complications.
Blood transfusions and total parenteral nutrition are also included		-
Grade IIIRequiring surgical, endoscopic, or radiological intervention
  • IIIa: Intervention not under general anesthesia
  • IIIb: Intervention under general anesthesia
-
Grade IVLife-threatening complication (including central nervous system complications) requiring IC/ICU management
  • IVa: Single-organ dysfunction (including dialysis)
  • IVb: Multiorgan dysfunction
-
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Grillo-Marín, C.; Antón-Rodríguez, C.; Prieto, L.; Ortega-Pérez, G.; González-Moreno, S. Nephrotoxicity Associated with Cytoreductive Surgery Combined with Cisplatin-Based Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Malignant Disease: A Systematic Review and Meta-Analysis. J. Clin. Med. 2024, 13, 3793. https://doi.org/10.3390/jcm13133793

AMA Style

Grillo-Marín C, Antón-Rodríguez C, Prieto L, Ortega-Pérez G, González-Moreno S. Nephrotoxicity Associated with Cytoreductive Surgery Combined with Cisplatin-Based Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Malignant Disease: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2024; 13(13):3793. https://doi.org/10.3390/jcm13133793

Chicago/Turabian Style

Grillo-Marín, Cristián, Cristina Antón-Rodríguez, Lola Prieto, Gloria Ortega-Pérez, and Santiago González-Moreno. 2024. "Nephrotoxicity Associated with Cytoreductive Surgery Combined with Cisplatin-Based Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Malignant Disease: A Systematic Review and Meta-Analysis" Journal of Clinical Medicine 13, no. 13: 3793. https://doi.org/10.3390/jcm13133793

APA Style

Grillo-Marín, C., Antón-Rodríguez, C., Prieto, L., Ortega-Pérez, G., & González-Moreno, S. (2024). Nephrotoxicity Associated with Cytoreductive Surgery Combined with Cisplatin-Based Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Malignant Disease: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine, 13(13), 3793. https://doi.org/10.3390/jcm13133793

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop