Corrected QT Prolongation in Cancer Patients after Cytoreductive Surgeries with Hyperthermic Intraperitoneal Chemotherapy (HIPEC): A Retrospective Observational Study

Background and Aims: Hyperthermic intraperitoneal chemotherapy (HIPEC) is an evolving anticancer treatment modality that can have a deleterious effect on the heart due to both hyperthermia and chemotherapeutic drugs. By prolonging corrected QT (QTc), HIPEC can increase the risk of arrhythmia, especially polymorphic ventricular tachycardia. This retrospective analysis aims to evaluate the incidence of QTc prolongation, its clinical presentation in the perioperative period, and its relationship with chemotherapeutic drugs in patients undergoing cancer surgeries. Methods: Perioperative data were collected from the hospital’s electronic medical record for 52 patients who had undergone cytoreductive surgeries along with HIPEC in the last year. Perioperative management was conducted as per institutional protocol. The records contained data pertaining to disease status and electrocardiogram details. Results: Among 52 patients, 30 patients (57.6%) received chemotherapy pre-operatively depending on the primary diagnosis, and 16 patients (30.7%) had a baseline QTc >440 ms. Fifty-one patients (98%) experienced QTc interval prolongation immediately after surgery (ΔQTc 58.6 ± 29.98 ms, P < 0.0001). The ΔQTc was >30 ms in 46 patients (88%), >60 ms in 21 (40%) and >100 ms in 3 (5.7%) patients. One patient developed ventricular bigeminy with ectopics (ΔQTc = 71 ms). Conclusion: We found that significant post-operative QT prolongation is associated with cytoreductive surgeries with HIPEC. The symptom manifestation was minimal, which may be due to aggressive electrolytes optimisation, especially magnesium.