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Acute Abdominal Complications in Deeply Neutropenic Onco-Hematology Patients: A Retrospective Series of 105 Cases

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Abstract

Background

Acute abdominal complications (AAC) in patients with deep neutropenia (DN) is challenging to manage because of the expected influence of AAC on oncological prognosis and higher surgical complication rate in a period of DN. In practice, these parameters are difficult to appreciate. This study reported our experience in managing these patients.

Methods

All consecutive patients treated in our tertiary care cancer center between 2010 and 2020 who developed AAC in the context of a DN were retrospectively analyzed. AAC was defined as an infection (intra-abdominal, perineal, or cutaneous), bowel obstruction, or intra-abdominal hemorrhage.

Findings

Among 105 patients, 18 (17%) required emergent surgery (group 1), 34 patients had a complication requiring surgical oversight (group 2), and 53 patients had a non-surgical etiology (group 3). Fifteen patients underwent surgery in the group 1, three in group 2, and one in group 3. Overall, 28 patients died during hospitalization. Mortality was statistically different between the groups (p = 0·01), with a higher rate in group 1 (n = 9/18, 50%) than in group 2 (n = 11/34, 32%) and group 3 (n = 8/53, 15%). All groups together had a median overall survival (OS) of 14 months and disease-free survival (DFS) of 10 months. OS was not comparable between the groups, and the median length of survival in group 1 was 6 months versus 8 months in group 2 and 23 months in group 3. In group 1, five patients (5/18, 28%) did not relapse at the end of the follow-up compared to 13 in group 2 (13/34, 38%) and 25 in group 3 (25/53, 47%). After discharge, OS and DFS were similar between the groups.

Interpretation

The advent of an AAC necessitating surgery in the context of DN is a deadly event associated with a 50% mortality; nonetheless, in case of unpostponable emergencies, surgery can provide long-term survival in selected patients.

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References

  1. Freifeld AG, Bow EJ, Sepkowitz KA et al (2011) Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis 52:e56-93

    Article  Google Scholar 

  2. Hughes WT, Armstrong D, Bodey GP et al (2002) 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 34:730–751

    Article  Google Scholar 

  3. Forrest GN, Schimpff SC, Cross A (2002) Febrile neutropenia, colony-stimulating factors and therapy: time for a new methodology? Support Care Cancer 10:177–180

    Article  Google Scholar 

  4. Rapoport BL, Aapro M, Paesmans M et al (2018) Febrile neutropenia (FN) occurrence outside of clinical trials: occurrence and predictive factors in adult patients treated with chemotherapy and an expected moderate FN risk. Rationale and design of a real-world prospective, observational, multinational study. BMC Cancer. https://doi.org/10.1186/s12885-018-4838-z

    Article  PubMed  PubMed Central  Google Scholar 

  5. Gorschlüter M, Mey U, Strehl J et al (2005) Neutropenic enterocolitis in adults: systematic analysis of evidence quality. Eur J Haematol 75:1–13

    Article  Google Scholar 

  6. Hohenberger P, Buchheidt D (2005) Surgical interventions in patients with hematologic malignancies. Crit Rev Oncol Hematol 55:83–91

    Article  Google Scholar 

  7. Esposito S, Bassetti M, Concia E et al (2017) Diagnosis and management of skin and soft-tissue infections (SSTI). A literature review and consensus statement: an update. J Chemother. 29:197–214

    Article  CAS  Google Scholar 

  8. Averbuch D, Orasch C, Cordonnier C et al (2013) European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia. Haematologica 98:1826–1835

    Article  Google Scholar 

  9. Guarana M, Nucci M, Nouér SA (2009) Shock and early death in hematologic patients with febrile neutropenia. Antimicrob Agents Chemother. https://doi.org/10.1128/AAC.01250-19

    Article  Google Scholar 

  10. Azoulay E, Mokart D, Pène F et al (2013) Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium–a groupe de recherche respiratoire en réanimation onco-hématologique study. J Clin Oncol 31:2810–2818

    Article  Google Scholar 

  11. Lebon D, Biard L, Buyse S et al (2017) Gastrointestinal emergencies in critically ill cancer patients. J Crit Care 40:69–75

    Article  Google Scholar 

  12. Solomkin JS, Mazuski JE, Bradley JS et al (2010) Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the surgical infection society and the infectious diseases society of America. Clin Infect Dis 50:133–164

    Article  Google Scholar 

  13. Bala M, Kashuk J, Moore EE et al (2017) Acute mesenteric ischemia: guidelines of the world society of emergency surgery. World J Emerg Surg 12:38

    Article  Google Scholar 

  14. Jung N, Eckmann C (2019) Essentials in the management of necrotizing soft-tissue infections. Infection 47:677–679

    Article  Google Scholar 

  15. Mayumi T, Okamoto K, Takada T et al (2018) Tokyo Guidelines 2018: management bundles for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 25:96–100

    Article  Google Scholar 

  16. Findlay JM, Kafsi JE, Hammer C, Gilmour J, Gillies RS, Maynard ND (2016) Nonoperative management of appendicitis in adults: a systematic review and meta-analysis of randomized controlled trials. J Am Coll Surg 223:814-824.e2

    Article  Google Scholar 

  17. Rodrigues FG, Dasilva G, Wexner SD (2017) Neutropenic enterocolitis. World J Gastroenterol 23:42–47

    Article  Google Scholar 

  18. Guh AY, Kutty PK (2018) Clostridioides difficile Infection. Ann Intern Med 169:ITC49-64

    Article  Google Scholar 

  19. Rami Reddy SR, Cappell MS (2017) A systematic review of the clinical presentation, diagnosis, and treatment of small bowel obstruction. Curr Gastroenterol Rep 19:28

    Article  Google Scholar 

  20. Garnett C, Apperley JF, Pavlů J (2013) Treatment and management of graft-versus-host disease: improving response and survival. Ther Adv Hematol 4:366–378

    Article  CAS  Google Scholar 

  21. Littlewood KE (2008) The immunocompromised adult patient and surgery. Best Pract Res Clin Anaesthesiol 22:585–609

    Article  Google Scholar 

  22. Saillard C, Zafrani L, Darmon M et al (2018) The prognostic impact of abdominal surgery in cancer patients with neutropenic enterocolitis: a systematic review and meta-analysis, on behalf the Groupe de Recherche en Réanimation Respiratoire du patient d’Onco-Hématologie (GRRR-OH). Ann Intensive Care 8:47

    Article  Google Scholar 

  23. Glenn J, Funkhouser WK, Schneider PS (1989) Acute illnesses necessitating urgent abdominal surgery in neutropenic cancer patients: description of 14 cases and review of the literature. Surgery 105:778–789

    CAS  PubMed  Google Scholar 

  24. Jolissaint JS, Harary M, Saadat LV et al (2019) Timing and outcomes of abdominal surgery in neutropenic patients. J Gastrointest Surg 23:643–650

    Article  Google Scholar 

  25. Antoun S, Elias D, Lasser P et al (2001) The medical and surgical management of acute abdominal complications in neutropenic cancer patient: description of 21 cases. Bull Cancer 88:426–34

    CAS  PubMed  Google Scholar 

  26. Chirletti P, Barillari P, Sammartino P et al (1993) The surgical choice in neutropenic patients with hematological disorders and acute abdominal complications. Leuk Lymphoma 9:237–241

    Article  CAS  Google Scholar 

  27. Scully RE, Mark EJ, McNeely WF, Ebeling SH, Phillips LD (1997) Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 20–1997. A 74-year-old man with progressive cough, dyspnea, and pleural thickening. N Engl J Med. 336:1895–903

    Article  CAS  Google Scholar 

  28. Weinberger M, Hollingsworth H, Feuerstein IM, Young NS, Pizzo PA (1993) Successful surgical management of neutropenic enterocolitis in two patients with severe aplastic anemia. Case reports and review of the literature. Arch Intern Med. 153:107–13

    Article  CAS  Google Scholar 

  29. Badgwell BD, Cormier JN, Wray CJ et al (2008) Challenges in surgical management of abdominal pain in the neutropenic cancer patient. Ann Surg 248:104–109

    Article  Google Scholar 

  30. Sachak T, Arnold MA, Naini BV et al (2015) Neutropenic enterocolitis: new insights into a deadly entity. Am J Surg Pathol 39:1635–1642

    Article  Google Scholar 

  31. Mokart D, Darmon M, Resche-Rigon M et al (2015) Prognosis of neutropenic patients admitted to the intensive care unit. Intensive Care Med 41:296–303

    Article  CAS  Google Scholar 

  32. Mokart D, Penalver M, Chow-Chine L et al (2017) Surgical treatment of acute abdominal complications in hematology patients: outcomes and prognostic factors. Leuk Lymphoma 58:2395–2402

    Article  Google Scholar 

  33. Raynard et al. Insuffisance hépatique et manifestations digestives en oncohématologie- ClinicalKey. https://vpn.gustaveroussy.fr/,DanaInfo=www.clinicalkey.fr,SSL+#!/content/book/3-s2.0-B9782294769283003012 (accessed Nov 4, 2020).

  34. Cohen JS, Paz IB, O’Donnell MR, Ellenhorn JD (1996) Treatment of perianal infection following bone marrow transplantation. Dis Colon Rectum 39:981–985

    Article  CAS  Google Scholar 

  35. Tengberg LT, Cihoric M, Foss NB et al (2017) Complications after emergency laparotomy beyond the immediate postoperative period - a retrospective, observational cohort study of 1139 patients. Anaesthesia 72:309–316

    Article  CAS  Google Scholar 

  36. Zuckermann J, Moreira LB, Stoll P, Moreira LM, Kuchenbecker RS, Polanczyk CA (2008) Compliance with a critical pathway for the management of febrile neutropenia and impact on clinical outcomes. Ann Hematol 87:139–145

    Article  CAS  Google Scholar 

  37. Keng MK, Thallner EA, Elson P et al (2015) Reducing time to antibiotic administration for febrile neutropenia in the emergency department. J Oncol Pract 11:450–455

    Article  Google Scholar 

  38. Ko BS, Ahn S, Lee Y-S, Kim WY, Lim KS, Lee J-L (2015) Impact of time to antibiotics on outcomes of chemotherapy-induced febrile neutropenia. Support Care Cancer 23:2799–2804

    Article  Google Scholar 

  39. Koea JB, Shaw JH (1989) Surgical management of neutropenic enterocolitis. Br J Surg 76:821–824

    Article  CAS  Google Scholar 

  40. Dumont F, Goéré D, Honoré C, Elias D (2015) Abdominal surgical emergencies in patients with advanced cancer. J Visc Surg 152:S91-96

    Article  CAS  Google Scholar 

  41. Brodin P, Gilg S, Lundell L, Mattsson J (2012) Major surgery in a neutropenic patient undergoing allogeneic stem cell transplantation for high risk myelofibrosis. Int J Hematol 96:798–800

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgical Oncology, Gustave Roussy Cancer Campus, 114, Rue Edouard Vaillant, 94805, Villejuif, France

    Matthieu Siebert, Maximiliano Gelli, Isabelle sourrouille, Léonor Benhaïm, Matthieu Faron & Charles Honoré

  2. Department of Intensive Care, Gustave Roussy Cancer Campus, Villejuif, France

    Nolwenn Lucas & Annabelle Stoclin

  3. Department of Haematology, Gustave Roussy Cancer Campus, Villejuif, France

    Jean-Baptiste Micol

  4. Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France

    Michel Ducreux

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  1. Matthieu Siebert
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Correspondence to Matthieu Siebert.

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Siebert, M., Lucas, N., Gelli, M. et al. Acute Abdominal Complications in Deeply Neutropenic Onco-Hematology Patients: A Retrospective Series of 105 Cases. World J Surg 46, 2389–2398 (2022). https://doi.org/10.1007/s00268-022-06653-3

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