Leakage of albumin levels during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy predicts the major complications

Background: Little is known about the clinical consequences of perioperative extravasation of albumin that inevitably accompanies major abdominal surgery. Methods: We retrospectively reviewed the data of patients who underwent cytoreductive surgery (CRS) and hyperthermic in-traoperative peritoneal chemotherapy (HIPEC). Parameters of albumin kinetics, including a de-crease in serum albumin concentration (Alb) and the amount of extravasated albumin (Albshift), were assessed from surgery until postoperative day (POD) 3. Major postoperative complications were defined as Clavien–Dindo Class III-IV. Logistic regression analysis identified independent predictors of major postoperative complications. The predictive ability of albumin kinetics was evaluated using receiver operating characteristic (ROC) curve analysis. Results: Serum albumin levels decreased during surgery and subsequently increased. Of the 121 analyzed patients, 25 (21%) developed major postoperative complications. The Alb and Albshift during surgery and on POD3 were greater in patients who developed major complications than in those who did not (12 ± 12 vs. 6 ± 14, P = 0.032 and 127.5 (71.9) vs. 48.5 (44.9), P < 0.001, respectively). Perioperative Alb and Albshift were associated with major postoperative complications. The area under the ROC curve of Albshift during 3 days after surgery and Albshift up to POD3 were 0.843 (95% confidence interval [CI]: 0.761-0.924) and 0.910 (95% CI: 0.856-0.964), respectively. Albshift during 3 days after surgery and Albshift up to POD3 were predictive of complications (P < 0.05). Conclusion: Perioperative albumin loss is closely associated with major postoperative complications in patients undergoing CRS and HIPEC. Albshift was an effective predictive factor for serious complications.