Perioperative considerations in the oncologic patient undergoing isolated limb perfusion

Isolated limb perfusion (ILP) and hyperthermic ILP (HILP) are therapeutic options for patients with unresectable malignancies in the extremities (e.g., primarily melanoma and soft tissue tumors), they induce a high rate of tumor response; associates with high limb salvage rates and represents an effective alternative to amputation. These are challenging procedures with a high technical difficulty that require the efforts of a multidisciplinary team (surgeon, anesthesiologist, nurse, perfusionist and intensivist). Hemodynamic changes, drug leakage through collateral vessels, local and systemic toxicity, and potential complications require continuous and invasive monitoring during the procedure and rigorous post-surgical monitoring. The purpose of this review article was to update the strategies for the perioperative care of cancer patients undergoing this procedure.