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HIPEC as a risk factor for postoperative coagulopathy after cytoreductive surgery for peritoneal metastases

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Abstract

Aim of the study

Postoperative coagulopathy is a poorly investigated condition after Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). This study aims to evaluate the occurrence and risk factors of coagulative disorders after surgery for peritoneal metastases.

Patients and methods

The records were extracted from a prospectively maintained database of consecutive patients who underwent CRS between January 2018 and September 2020. The study was approved by the local Ethics Committee. For each patient, the coagulation profile (CP), which included international normalized ratio (INR), partial thromboplastin time (aPTT), and platelets (PLTS) before surgery, intensive care unit admission,1st, 3rd, 5th postoperative day (POD) and the day before discharge was collected. Risk factors for postoperative coagulopathy were identified at multivariate analysis.

Results

During the study period, 125 patients were included in the study. Among these, 48 (38.4%) underwent CRS only, and 77 (61.6%) CRS followed by HIPEC. Twenty-one patients (16.8%) developed severe coagulopathy, 5 (10.4%) after CRS and 16 (20.8%) after CRS-HIPEC. At multivariate analysis, HIPEC and blood loss ≥ 500 ml represented independent risk factors for severe alteration of INR > 1.5 (p = 0.05, OR 1.2) and PLTS < 75 109/L (p = 0.03, OR 1.3), respectively.

Conclusion

HIPEC is an independent risk factor for postoperative coagulopathy after CRS. Further studies are necessary to assess the usefulness of the point-of-care test in patients treated with CRS-HIPEC.

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Authors and Affiliations

  1. Advanced Surgical Oncology Unit, Unit of Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Via dei Carpani, 16/Z, Castelfranco Veneto (TV), 31033, Padua, Italy

    Antonio Sommariva, Marco Tonello, Emanuele Migliori, Elisa Pizzolato, Carola Cenzi, Marica Mirabella & Pierluigi Pilati

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  1. Antonio Sommariva
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  3. Emanuele Migliori
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  7. Pierluigi Pilati
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Contributions

Conceptualization: AS, MT, PP; methodology: AS, MT; investigation: AS, MT; data acquisition and curation: EM, EP, CC, MM; data analysis: AS, MT; writing (original draft preparation): AS, MT; writing (review and editing): AS, MT, EM, EP, CC; supervision: AS, PP. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Antonio Sommariva.

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Conflict of interest

The authors have no conflicts of interest or financial ties to disclose.

Ethics approval

This retrospective study was approved by the Ethics Committee of the Veneto Institute of Oncology IOV-IRCCS (Qualy-HIPEC CE IOV 2018/85).

Human participants and/or animals

This study is a retrospective study, only involving case text and data analysis, not directly involving human and animal.

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Consent to participate, Informed consent to participate was obtained from all the patients of this study.

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Sommariva, A., Tonello, M., Migliori, E. et al. HIPEC as a risk factor for postoperative coagulopathy after cytoreductive surgery for peritoneal metastases. Updates Surg 74, 1715–1723 (2022). https://doi.org/10.1007/s13304-022-01340-3

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