Skip to main content

Advertisement

SpringerLink
Log in

Identifying the incidence of respiratory complications following diaphragmatic cytoreduction and hyperthermic intraoperative intraperitoneal chemotherapy

  • Research Article
  • Published:
Clinical and Translational Oncology Aims and scope Submit manuscript

Abstract

Introduction

In patients with peritoneal carcinomatosis (PC), the incidence of respiratory complications following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is not well established. We aimed to describe the center-specific incidence and patient characteristics associated with respiratory complications following CRS and HIPEC in patients receiving treatment for PC.

Materials and methods

We used the University Hospital of Arrixaca study database to identify patients who underwent CRS and HIPEC for PC. Patients who experienced a post-operative respiratory complication were categorized according to the National Cancer Institute-Common Terminology Criteria for Adverse Events. Multivariable regression methods were used to identify independent risk factors for developing a respiratory complication following CRS and HIPEC.

Results

Between 2008 and 2017, we identified 247 patients who underwent CRS and HIPEC for PC. A total of eight patients (3.2%) were categorized as having a post-operative respiratory complication. A diaphragmatic peritonectomy and a PC index of > 14 were identified as independent risk factors for developing a respiratory complication. Radiographic evidence of a pleural effusion was identified in 72 patients who had CRS of the diaphragmatic peritoneum; however, only 6 (8.3%) of these patients required pleural drainage.

Conclusions

Only 3.2% of patients developed a symptomatic respiratory complication following CRS and HIPEC. A pleural effusion was identified in almost all patients requiring a diaphragmatic peritonectomy as part of their CRS; however, less than one in ten of these patients required pleural drainage. Prophylactic insertion of a pleural drainage tube is, therefore, not indicated following CRS and HIPEC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

ASA:

American Society Anaesthesiologists

CRS:

Cytoreductive surgery

ECOG:

Eastern Cooperative Oncology score

HIPEC:

Hyperthermic intraperitoneal chemotherapy

INR:

International normalized ratio

ITU:

Intensive care unit

NCI-CTCAE:

National Cancer Institute-Common Terminology Criteria for Adverse Events

OR:

Odds ratio

PC:

Peritoneal carcinomatosis

PCI:

Peritoneal carcinomatosis index

SD:

Standard deviation

References

  1. Hoskins WJ. Epithelial ovarian carcinoma: principles of primary surgery. Gynecol Oncol. 1994;55:S91–6. https://doi.org/10.1006/gyno.1994.1346.

    Article  CAS  PubMed  Google Scholar 

  2. Muñoz-Casares FC, Rufián S, Rubio MJ, Díaz CJ, Díaz R, Casado A, et al. The role of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) in the treatment of peritoneal carcinomatosis in recurrent ovarian cancer. Clin Transl Oncol. 2009;11:753–9.

    Article  Google Scholar 

  3. Shih KK, Chi DS. Maximal cytoreductive effort in epithelial ovarian cancer surgery. J Gynecol Oncol. 2010;21:75–80. https://doi.org/10.3802/jgo.2010.21.2.75.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Chi DS, Eisenhauer EL, Lang J, Huh J, Haddad L, Abu-Rustum NR, et al. What is the optimal goal of primary cytoreductive surgery for bulky stage IIIC epithelial ovarian carcinoma (EOC)? Gynecol Oncol. 2006;103:559–64. https://doi.org/10.1016/j.ygyno.2006.03.051.

    Article  CAS  PubMed  Google Scholar 

  5. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013;63:11–30. https://doi.org/10.3322/caac.21166.

    Article  PubMed  Google Scholar 

  6. Benedetti Panici P, Di Donato V, Fischetti M, Casorelli A, Perniola G, Musella A, et al. Predictors of postoperative morbidity after cytoreduction for advanced ovarian cancer: analysis and management of complications in upper abdominal surgery. Gynecol Oncol. 2015;137:406–11. https://doi.org/10.1016/j.ygyno.2015.03.043.

    Article  PubMed  Google Scholar 

  7. Eisenhauer EL, D’Angelica MI, Abu-Rustum NR, Sonoda Y, Jarnagin WR, Barakat RR, et al. Incidence and management of pleural effusions after diaphragm peritonectomy or resection for advanced mullerian cancer. Gynecol Oncol. 2006;103:871–7. https://doi.org/10.1016/j.ygyno.2006.05.023.

    Article  PubMed  Google Scholar 

  8. U.S. Department of Health and Human Services. National Institutes of Health. National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. Published: May 28, 2009 (v4.03: June 14, 2010). n.d.

  9. Péus D, Newcomb N, Hofer S. Appraisal of the Karnofsky performance status and proposal of a simple algorithmic system for its evaluation. BMC Med Inform Decis Mak. 2013;13:72. https://doi.org/10.1186/1472-6947-13-72.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Gilly FN, Cotte E, Brigand C, Monneuse O, Beaujard AC, Freyer G, et al. Quantitative prognostic indices in peritoneal carcinomatosis. Eur J Surg Oncol. 2006;32:597–601. https://doi.org/10.1016/j.ejso.2006.03.002.

    Article  CAS  PubMed  Google Scholar 

  11. Sugarbaker PH. Management of peritoneal-surface malignancy: the surgeon’s role. Langenbeck’s Arch Surg. 1999;384:576–87.

    Article  CAS  Google Scholar 

  12. Cliby W, Dowdy S, Feitoza SS, Gostout BS, Podratz KC. Diaphragm resection for ovarian cancer: technique and short-term complications. Gynecol Oncol. 2004;94:655–60. https://doi.org/10.1016/j.ygyno.2004.04.032.

    Article  PubMed  Google Scholar 

  13. Dowdy SC, Loewen RT, Aletti G, Feitoza SS, Cliby W. Assessment of outcomes and morbidity following diaphragmatic peritonectomy for women with ovarian carcinoma. Gynecol Oncol. 2008;109:303–7. https://doi.org/10.1016/j.ygyno.2008.02.012.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Chéreau E, Rouzier R, Gouy S, Ferron G, Narducci F, Bergzoll C, et al. Morbidity of diaphragmatic surgery for advanced ovarian cancer: retrospective study of 148 cases. Eur J Surg Oncol. 2011;37:175–80. https://doi.org/10.1016/j.ejso.2010.10.004.

    Article  PubMed  Google Scholar 

  15. Montz FJ, Schlaerth JB, Berek JS. Resection of diaphragmatic peritoneum and muscle: role in cytoreductive surgery for ovarian cancer. Gynecol Oncol. 1989;35:338–40. https://doi.org/10.1016/0090-8258(89)90074-7.

    Article  CAS  PubMed  Google Scholar 

  16. Chéreau E, Ballester M, Selle F, Cortez A, Pomel C, Darai E, et al. Pulmonary morbidity of diaphragmatic surgery for stage III/IV ovarian cancer. BJOG An Int J Obstet Gynaecol. 2009;116:1062–8. https://doi.org/10.1111/j.1471-0528.2009.02214.x.

    Article  Google Scholar 

  17. Aletti GD, Dowdy SC, Gostout BS, Jones MB, Stanhope CR, Wilson TO, et al. Aggressive surgical effort and improved survival in advanced-stage ovarian cancer. Obstet Gynecol. 2006;107:77–85. https://doi.org/10.1097/01.AOG.0000192407.04428.bb.

    Article  PubMed  Google Scholar 

  18. Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol. 2002;20:1248–59. https://doi.org/10.1200/JCO.2002.20.5.1248.

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. P. Cascales Campos and L. A. Martinez Insfran contributed equally.

Authors and Affiliations

  1. Oncological Peritoneal Surgery Unit, General Surgery and Digestive Tract Department, University Hospital Virgen de la Arrixaca, IMIB-Arrixaca, Carretera Madrid-Cartagena S/N, El Palmar, CP 30120, Murcia, Spain

    P. Cascales Campos, L. A. Martinez Insfran, J. Gil, E. Gil, A. Gonzalez Gil & P. Parrilla

  2. Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK

    D. Wallace

  3. Oncology Department, University Hospital Virgen de la Arrixaca, IMIB-Arrixaca, Carretera Madrid-Cartagena S/N, El Palmar, CP 201220, Murcia, Spain

    J. Martínez & J. L. Alonso Romero

  4. Hepatology Unit, Digestive Tract Diseases Service, University Hospital Virgen de la Arrixaca, IMIB-Arrixaca, Carretera Madrid-Cartagena S/N, El Palmar, CP 201220, Murcia, Spain

    R. Gonzalez Sanchez

Authors
  1. P. Cascales Campos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. A. Martinez Insfran
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Wallace
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Gil
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. Gil
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Gonzalez Gil
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. Martínez
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. L. Alonso Romero
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. R. Gonzalez Sanchez
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. P. Parrilla
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. A. Martinez Insfran.

Ethics declarations

Conflict of interest

The authors of the research article entitled “Identifying the incidence of respiratory complications following diaphragmatic cytoreduction and hyperthermic intraoperative intraperitoneal chemotherapy” declare that there are no potential conflicts of interest.

Ethical approval

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all participants.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 12 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cascales Campos, P., Martinez Insfran, L.A., Wallace, D. et al. Identifying the incidence of respiratory complications following diaphragmatic cytoreduction and hyperthermic intraoperative intraperitoneal chemotherapy. Clin Transl Oncol 22, 852–859 (2020). https://doi.org/10.1007/s12094-019-02195-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12094-019-02195-8

Keywords

Search

Navigation