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Cytoreductive Surgery Combined with Hyperthermic Intraperitoneal Chemotherapy with Oxaliplatin Increases the Risk of Postoperative Hemorrhagic Complications: Analysis of Predictive Factors

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Treatment of peritoneal carcinomatosis (PC) using cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is recommended as curative treatment for selected patients. Modalities of HIPEC remain heterogeneous and HIPEC using oxaliplatin (HIPEC-Ox) appears to increase the risk of postoperative hemorrhagic complications (HCs).

Objective

The aim of this study was to assess the risk of HCs after CRS combined with HIPEC-Ox versus other drugs, and to determine predictive factors for HCs after HIPEC-Ox.

Methods

Data from 701 patients included in the National French Registry who were treated with CRS and HIPEC at 24 centers between 1998 and 2007 were used to evaluate the incidence of HCs following HIPEC with or without oxaliplatin. Overall, 771 patients treated with HIPEC-Ox at five French specialty centers were then analyzed to determine factors associated with the occurrence of HCs.

Results

The overall incidence of HCs was 9.8 %. When used with HIPEC, oxaliplatin significantly and independently increased the rate of HCs (15.7 vs. 2.6 % for other drugs; p = 0.004, odds ratio 32.4). Among the 771 patients who underwent HIPEC-Ox, HCs occurred in 14.3 % of patients. The only independent risk factor for HCs was an extended PC with a Peritoneal Cancer Index (PCI) >12 (p = 0.040).

Conclusion

HIPEC-Ox increases the risk of HCs compared with HIPEC with other drugs. The potential oncologic benefit of oxaliplatin and the risk of HCs should be considered in patients with PC who have a high PCI, as well as in at-risk patients.

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Acknowledgment

The authors thank Laurent Villeneuve, Emilie Mathiotte, Isabelle Bonnefoy, and Perrine Capolino for collecting the RENAPE and BIG RENAPE data.

Disclosure

Thibaut Charrier, Guillaume Passot, Julien Peron, Christelle Maurice, Sashka Gocevska, François Quénet, Clarisse Eveno, Marc Pocard, Diane Goere, Dominique Elias, Pablo Ortega-Deballon, Delphine Vaudoyer, Eddy Cotte, and Olivier Glehen have no conflicts of interest to declare.

Author information

Authors and Affiliations

  1. Department of General Surgery, Centre Hospitalier Lyon Sud, Pierre Bénite, France

    Thibaut Charrier MD, Guillaume Passot MD, Delphine Vaudoyer MD, Eddy Cotte MD, PhD & Olivier Glehen MD, PhD

  2. EMR 3738, Lyon 1 University, Lyon, France

    Thibaut Charrier MD, Guillaume Passot MD, Delphine Vaudoyer MD, Eddy Cotte MD, PhD & Olivier Glehen MD, PhD

  3. Department of Biostatistics, UMR 5558, Lyon 1 University, Lyon, France

    Julien Peron MD

  4. Pôle IMER, Unité de Recherche Clinique, Hospices Civils de Lyon, Lyon, France

    Christelle Maurice MSc

  5. Department of Surgery, Centre Val d’Aurelle, Montpellier, France

    Sashka Gocevska MD & François Quénet MD, PhD

  6. Department of Surgery, Hôpital Lariboisière, Assistance-Publique, des hôpitaux de Paris, Paris 7 Université Paris Diderot, Paris, France

    Clarisse Eveno MD, PhD & Marc Pocard MD, PhD

  7. Department of Surgery, Gustave Roussy, Cancer Campus, Grand Paris, Paris, France

    Diane Goere MD, PhD & Dominique Elias MD, PhD

  8. Department of Surgery, Centre Hospitalier Universitaire de Dijon, Dijon, France

    Pablo Ortega-Deballon MD, PhD

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  1. Thibaut Charrier MD
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  2. Guillaume Passot MD
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  14. Olivier Glehen MD, PhD
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Corresponding author

Correspondence to Olivier Glehen MD, PhD.

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On behalf of the BIG-RENAPE Group.

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Charrier, T., Passot, G., Peron, J. et al. Cytoreductive Surgery Combined with Hyperthermic Intraperitoneal Chemotherapy with Oxaliplatin Increases the Risk of Postoperative Hemorrhagic Complications: Analysis of Predictive Factors. Ann Surg Oncol 23, 2315–2322 (2016). https://doi.org/10.1245/s10434-016-5143-1

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  • DOI: https://doi.org/10.1245/s10434-016-5143-1

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