Minimizing acute kidney injury in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: institutional insights into goal-directed fluid therapy and epidural analgesia.

We read with interest the meta-analysis by Chen et al. on postoperative acute kidney injury (AKI) following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) published in World Journal of Surgical Oncology. In response, we share our institutional experience using a standardized perioperative protocol incorporating goal-directed fluid therapy (GDFT) and epidural analgesia. This approach was intended to support hemodynamic stability and provide effective analgesia. Among 92 patients undergoing CRS + HIPEC, the incidence of postoperative AKI was 2.2%, which was lower than the rates reported in prior studies. However, our cohort had fewer comorbidities and lower perioperative risk profiles than those included in the meta-analysis, representing an important limitation when interpreting these findings. Taken together, our experience suggests that perioperative strategies such as GDFT and epidural analgesia, combined with favorable baseline characteristics, may contribute to reduced AKI risk in this high-risk population. Larger prospective multicenter studies are warranted to validate these observations.