Skip to main content

Advertisement

SpringerLink
Log in

Does Intraoperative Systematic Bacterial Sampling During Complete Cytoreductive Surgery (CRS) with Hyperthermic Intraoperative Peritoneal Chemotherapy (HIPEC) Influence Postoperative Treatment? A New Predictive Factor for Postoperative Abdominal Infectious Complications

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is an emerging curative treatment option for patients with peritoneal carcinomatosis. It has a long-term survival benefit but is associated with high rates of morbidity, ranging from 12 % to 65 %, mainly due to infectious complications. We sought to evaluate the clinical relevance of routine intraoperative bacteriological sampling following CRS/HIPEC.

Study design

Between November 2010 and December 2014, every patients receiving CRS/HIPEC were included. Three samples were routinely collected from standardized locations for intraperitoneal rinsing liquid bacteriological analysis (RLBA) after completion of HIPEC. The clinical and surgical features, bacteriological results, and short-term outcomes were retrospectively reviewed.

Results

The overall mortality and morbidity rates were 5 and 45 %, respectively. Among the 75 included patients, 40 % (n = 30) had at least one positive bacterial culture. Risk factors for a positive culture were colorectal resection (adjusted hazard ratio [HR] = 3.072, 95 % CI 1.843–8.004; p = 0.009) and blood loss >1000 mL (HR = 4.272, 95 % CI 1.080–18.141; p = 0.031). Among 26 (35 %) patients with abdominal infectious complications, 13 (17 %) experienced isolated complications. A positive RLBA result was independently associated with abdominal infectious complications (HR = 5.108, 95 % CI 1.220–16.336; p = 0.024) and isolated abdominal infectious complications (HR = 4.199, 95 % CI 1.064–15.961; p = 0.04).

Conclusions

Forty percent of the RLBA samples obtained following CRS/HIPEC tested positive for bacteria. Bacterial sampling of rinsing liquid should be systematically performed. An aggressive and immediate antibiotic strategy needs to be evaluated.

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

Similar content being viewed by others

References

  1. Verwaal VJ, Bruin S, Boot H et al (2008) 8-year follow-up of randomized trial: cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer. Ann Surg Oncol 15:2426–2432. doi:10.1245/s10434-008-9966-2

    Article  PubMed  Google Scholar 

  2. Glehen O, Kwiatkowski F, Sugarbaker PH et al (2004) Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol 22:3284–3292. doi:10.1200/JCO.2004.10.012

    Article  CAS  PubMed  Google Scholar 

  3. Jayne DG, Fook S, Loi C, Seow-Choen F (2002) Peritoneal carcinomatosis from colorectal cancer. Br J Surg 89:1545–1550. doi:10.1046/j.1365-2168.2002.02274.x

    Article  CAS  PubMed  Google Scholar 

  4. Glehen O, Gilly FN, Boutitie F et al (2010) Toward curative treatment of peritoneal carcinomatosis from nonovarian origin by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy: a multi-institutional study of 1,290 patients. Cancer 116:5608–5618. doi:10.1002/cncr.25356

    Article  PubMed  Google Scholar 

  5. Kuijpers AMJ, Mirck B, Aalbers AGJ et al (2013) Cytoreduction and HIPEC in the Netherlands: nationwide long-term outcome following the Dutch protocol. Ann Surg Oncol 20:4224–4230. doi:10.1245/s10434-013-3145-9

    Article  PubMed  PubMed Central  Google Scholar 

  6. Moran B, Cecil T, Chandrakumaran K et al (2015) The results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1200 patients with peritoneal malignancy. Colorectal Dis 17:772–778. doi:10.1111/codi.12975

    Article  CAS  PubMed  Google Scholar 

  7. Chua TC, Saxena A, Schellekens JF et al (2010) Morbidity and mortality outcomes of cytoreductive surgery and perioperative intraperitoneal chemotherapy at a single tertiary institution: towards a new perspective of this treatment. Ann Surg 251:101–106. doi:10.1097/SLA.0b013e3181b5ae43

    Article  PubMed  Google Scholar 

  8. Kusamura S, Younan R, Baratti D et al (2006) Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion: analysis of morbidity and mortality in 209 peritoneal surface malignancies treated with closed abdomen technique. Cancer 106:1144–1153. doi:10.1002/cncr.21708

    Article  PubMed  Google Scholar 

  9. Verwaal VJ, van Tinteren H, Ruth SV, Zoetmulder FAN (2004) Toxicity of cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy. J Surg Oncol 85:61–67. doi:10.1002/jso.20013

    Article  PubMed  Google Scholar 

  10. Sugarbaker PH, Alderman R, Edwards G et al (2006) Prospective morbidity and mortality assessment of cytoreductive surgery plus perioperative intraperitoneal chemotherapy to treat peritoneal dissemination of appendiceal mucinous malignancy. Ann Surg Oncol 13:635–644. doi:10.1245/ASO.2006.03.079

    Article  PubMed  Google Scholar 

  11. Schwarz L, Votanopoulos K, Morris D (2015) is the combination of distal pancreatectomy and cytoreductive surgery with hipec reasonable? results of an International Multicenter Study. Ann Surg. doi:10.1097/SLA.0000000000001225

    Google Scholar 

  12. Capone A, Valle M, Proietti F et al (2007) Postoperative infections in cytoreductive surgery with hyperthermic intraperitoneal intraoperative chemotherapy for peritoneal carcinomatosis. J Surg Oncol 96:507–513. doi:10.1002/jso.20837

    Article  CAS  PubMed  Google Scholar 

  13. Valle M, Federici O, Carboni F et al (2014) Postoperative infections after cytoreductive surgery and HIPEC for peritoneal carcinomatosis: proposal and results from a prospective protocol study of prevention, surveillance and treatment. Eur J Surg Oncol 40:950–956. doi:10.1016/j.ejso.2013.10.015

    Article  CAS  PubMed  Google Scholar 

  14. Honoré C, Sourrouille I, Suria S et al (2013) Postoperative peritonitis without an underlying digestive fistula after complete cytoreductive surgery plus HIPEC. Saudi J Gastroenterol 19:271–277. doi:10.4103/1319-3767.121033

    Article  PubMed  PubMed Central  Google Scholar 

  15. Alfonsi P, Slim K, Chauvin M et al (2014) French guidelines for enhanced recovery after elective colorectal surgery. J Visc Surg 151:65–79. doi:10.1016/j.jviscsurg.2013.10.006

    Article  CAS  PubMed  Google Scholar 

  16. Gustafsson UO, Scott MJ, Schwenk W et al (2012) Guidelines for perioperative care in elective colonic surgery: enhanced Recovery After Surgery (ERAS®) Society recommendations. Clin Nutr Edinb Scotl 31:783–800. doi:10.1016/j.clnu.2012.08.013

    Article  CAS  Google Scholar 

  17. Hegazi RA, Hustead DS, Evans DC (2014) Preoperative standard oral nutrition supplements vs immunonutrition: results of a systematic review and meta-analysis. J Am Coll Surg 219:1078–1087. doi:10.1016/j.jamcollsurg.2014.06.016

    Article  PubMed  Google Scholar 

  18. Portilla AG, Shigeki K, Dario B, Marcello D (2008) The intraoperative staging systems in the management of peritoneal surface malignancy. J Surg Oncol 98:228–231. doi:10.1002/jso.21068

    Article  PubMed  Google Scholar 

  19. Jacquet P, Sugarbaker PH (1996) Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res 82:359–374

    Article  CAS  PubMed  Google Scholar 

  20. Sugarbaker PH (1998) Intraperitoneal chemotherapy and cytoreductive surgery for the prevention and treatment of peritoneal carcinomatosis and sarcomatosis. Semin Surg Oncol 14:254–261

    Article  CAS  PubMed  Google Scholar 

  21. Sugarbaker PH (1995) Peritonectomy procedures. Ann Surg 221:29–42

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  23. Stephens AD, Alderman R, Chang D et al (1999) Morbidity and mortality analysis of 200 treatments with cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy using the coliseum technique. Ann Surg Oncol 6:790–796

    Article  CAS  PubMed  Google Scholar 

  24. Glehen O, Osinsky D, Cotte E et al (2003) Intraperitoneal chemohyperthermia using a closed abdominal procedure and cytoreductive surgery for the treatment of peritoneal carcinomatosis: morbidity and mortality analysis of 216 consecutive procedures. Ann Surg Oncol 10:863–869

    Article  CAS  PubMed  Google Scholar 

  25. Jagannath P, Dhir V, Shrikhande S et al (2005) Effect of preoperative biliary stenting on immediate outcome after pancreaticoduodenectomy. Br J Surg 92:356–361. doi:10.1002/bjs.4864

    Article  CAS  PubMed  Google Scholar 

  26. Limongelli P, Pai M, Bansi D et al (2007) Correlation between preoperative biliary drainage, bile duct contamination, and postoperative outcomes for pancreatic surgery. Surgery 142:313–318. doi:10.1016/j.surg.2007.04.022

    Article  PubMed  Google Scholar 

  27. Augenstein VA, Reuter NP, Bower MR et al (2010) Bile cultures: a guide to infectious complications after pancreaticoduodenectomy. J Surg Oncol 102:478–481. doi:10.1002/jso.21612

    Article  PubMed  Google Scholar 

  28. Velthuis S, Veltcamp Helbach M, Tuynman JB et al (2015) Intra-abdominal bacterial contamination in TAMIS total mesorectal excision for rectal carcinoma: a prospective study. Surg Endosc. doi:10.1007/s00464-015-4089-x

    PubMed Central  Google Scholar 

  29. Cortes A, Sauvanet A, Bert F et al (2006) Effect of bile contamination on immediate outcomes after pancreaticoduodenectomy for tumor. J Am Coll Surg 202:93–99. doi:10.1016/j.jamcollsurg.2005.09.006

    Article  PubMed  Google Scholar 

  30. Montravers P, Gauzit R, Muller C et al (1996) Emergence of antibiotic-resistant bacteria in cases of peritonitis after intraabdominal surgery affects the efficacy of empirical antimicrobial therapy. Clin Infect Dis 23:486–494

    Article  CAS  PubMed  Google Scholar 

  31. Mosdell DM, Morris DM, Voltura A et al (1991) Antibiotic treatment for surgical peritonitis. Ann Surg 214:543–549

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Bosscha K, van Vroonhoven TJ, van der Werken C (1999) Surgical management of severe secondary peritonitis. Br J Surg 86:1371–1377. doi:10.1046/j.1365-2168.1999.01258.x

    Article  CAS  PubMed  Google Scholar 

  33. Bratzler DW, Dellinger EP, Olsen KM et al (2013) Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health-Syst Pharm 70:195–283. doi:10.2146/ajhp120568

    Article  CAS  PubMed  Google Scholar 

  34. 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. doi:10.1086/649554

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Digestive Surgery, Hôpital Charles Nicolle, 1 rue de Germont, 76000, Rouen, France

    Marie Dazza, Lilian Schwarz, Julien Coget, Emmanuel Huet, Valérie Bridoux & Jean-Jacques Tuech

  2. Department of Bacteriology, Hôpital Charles Nicolle, Rouen, France

    Noelle Frebourg

  3. Department of Anesthesiology, Hôpital Charles Nicolle, Rouen, France

    Gregory Wood

  4. Surgical Intensive Care Unit, Hôpital Charles Nicolle, Rouen, France

    Benoit Veber

Authors
  1. Marie Dazza
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lilian Schwarz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Julien Coget
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Noelle Frebourg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gregory Wood
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Emmanuel Huet
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Valérie Bridoux
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Benoit Veber
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jean-Jacques Tuech
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jean-Jacques Tuech.

Ethics declarations

Conflict of interest

All authors declare that they have no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dazza, M., Schwarz, L., Coget, J. et al. Does Intraoperative Systematic Bacterial Sampling During Complete Cytoreductive Surgery (CRS) with Hyperthermic Intraoperative Peritoneal Chemotherapy (HIPEC) Influence Postoperative Treatment? A New Predictive Factor for Postoperative Abdominal Infectious Complications. World J Surg 40, 3035–3043 (2016). https://doi.org/10.1007/s00268-016-3635-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-016-3635-6

Keywords

Search

Navigation