Abstract
Purpose
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have become standard of care for many peritoneal malignancies in selected patients. Nevertheless, this aggressive treatment strategy is associated with significant major morbidity. The aim of the present study is to analyze the re-operation rate and clinical outcome following CRS and HIPEC.
Patients and methods
In the present study, prospectively documented data of 474 consecutive patients treated with CRS and HIPEC between February 2011 and December 2015 in a high-volume certified reference center for peritoneal malignancies in Germany have been retrospectively analyzed.
Results
The re-operation rate was 14.5%. The most frequent reasons for revisional surgery were fascial dehiscence, intraabdominal hemorrhage, and anastomotic leak. Most complications occurred between postoperative day 7 and 9. However, postoperative bleeding was more common within the first 5 days after surgery. The overall in-hospital mortality rate was 2.1% for all patients and 10% after revisional surgery.
Conclusions
CRS and HIPEC are associated with an acceptable re-operation rate and low mortality rate. Most frequently, re-operations are performed on 7–9 days after initial surgery due to fascial dehiscence, pancreatitis, or anastomotic leak. Postoperative bleedings are more common within the first 5 days after surgery.
Similar content being viewed by others
References
Sugarbaker PH (1995) Peritonectomy procedures. Ann Surg 221(1):29–42
Sugarbaker PH (2003) Peritonectomy procedures. Surg Oncol Clin N Am 12(3):703–727 xiii
Stewart JH, Shen P, Levine EA (2005) Intraperitoneal hyperthermic chemotherapy for peritoneal surface malignancy: current status and future directions. Ann Surg Oncol 12(10):765–777. https://doi.org/10.1245/ASO.2005.12.001
Chua TC, Yan TD, Saxena A, Morris DL (2009) Should the treatment of peritoneal carcinomatosis by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy still be regarded as a highly morbid procedure?: a systematic review of morbidity and mortality. Ann Surg 249(6):900–907
Baratti D, Kusamura S, Mingrone E, Balestra MR, Laterza B, Deraco M (2012) Identification of a subgroup of patients at highest risk for complications after surgical cytoreduction and hyperthermic intraperitoneal chemotherapy. Ann Surg 256(2):334–341. https://doi.org/10.1097/SLA.0b013e31825704e3
Moran B, Cecil T, Chandrakumaran K, Arnold S, Mohamed F, Venkatasubramaniam A (2015) The results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1200 patients with peritoneal malignancy. Color Dis 17(9):772–778. https://doi.org/10.1111/codi.12975
Jafari MD, Halabi WJ, Stamos MJ, Nguyen VQ, Carmichael JC, Mills SD, Pigazzi A (2014) Surgical outcomes of hyperthermic intraperitoneal chemotherapy: analysis of the American college of surgeons national surgical quality improvement program. JAMA Surg 149(2):170–175. https://doi.org/10.1001/jamasurg.2013.3640
Tabrizian P, Shrager B, Jibara G, Yang MJ, Romanoff A, Hiotis S, Sarpel U, Labow DM (2014) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis: outcomes from a single tertiary institution. J Gastrointest Surg 18(5):1024–1031. https://doi.org/10.1007/s11605-014-2477-5
Jimenez W, Sardi A, Nieroda C, Sittig M, Milovanov V, Nunez M, Aydin N, Gushchin V (2014) Predictive and prognostic survival factors in peritoneal carcinomatosis from appendiceal cancer after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol 21(13):4218–4225. https://doi.org/10.1245/s10434-014-3869-1
Konigsrainer I, Horvath P, Struller F, Grischke EM, Wallwiener D, Konigsrainer A, Beckert S (2014) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in recurrent epithelial ovarian cancer with peritoneal metastases: a single center experience. Langenbeck's Arch Surg 399(5):589–594. https://doi.org/10.1007/s00423-014-1207-5
Konigsrainer I, Zieker D, Glatzle J, Lauk O, Klimek J, Symons S, Brucher B, Beckert S, Konigsrainer A (2012) Experience after 100 patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. World J Gastroenterol 18(17):2061–2066. https://doi.org/10.3748/wjg.v18.i17.2061
Jacquet P, Sugarbaker PH (1996) Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res 82:359–374
Glehen O, Gilly FN (2003) Quantitative prognostic indicators of peritoneal surface malignancy: carcinomatosis, sarcomatosis, and peritoneal mesothelioma. Surg Oncol Clin N Am 12(3):649–671
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213
Mizumoto A, Canbay E, Hirano M, Takao N, Matsuda T, Ichinose M, Yonemura Y (2012) Morbidity and mortality outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy at a single institution in Japan. Gastroenterol Res Pract 2012:836425–836425. https://doi.org/10.1155/2012/836425
Froysnes IS, Larsen SG, Spasojevic M, Dueland S, Flatmark K (2016) Complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastasis in Norway: prognostic factors and oncologic outcome in a national patient cohort. J Surg Oncol 114(2):222–227. https://doi.org/10.1002/jso.24290
Jacquet P, Stephens AD, Averbach AM, Chang D, Ettinghausen SE, Dalton RR, Steves MA, Sugarbaker PH (1996) Analysis of morbidity and mortality in 60 patients with peritoneal carcinomatosis treated by cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy. Cancer 77(12):2622–2629. https://doi.org/10.1002/(SICI)1097-0142(19960615)77:12<2622::AID-CNCR28>3.0.CO;2-T
Stephens AD, Alderman R, Chang D, Edwards GD, Esquivel J, Sebbag G, Steves MA, Sugarbaker PH (1999) Morbidity and mortality analysis of 200 treatments with cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy using the coliseum technique. Ann Surg Oncol 6(8):790–796
Sugarbaker PH, Alderman R, Edwards G, Marquardt CE, Gushchin V, Esquivel J, Chang D (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(5):635–644. https://doi.org/10.1245/ASO.2006.03.079
Roviello F, Marrelli D, Neri A, Cerretani D, de Manzoni G, Pedrazzani C, Cioppa T, Nastri G, Giorgi G, Pinto E (2006) Treatment of peritoneal carcinomatosis by cytoreductive surgery and intraperitoneal hyperthermic chemoperfusion (IHCP): postoperative outcome and risk factors for morbidity. World J Surg 30(11):2033–2040; discussion 2041-2032. https://doi.org/10.1007/s00268-006-0038-0
Kusamura S, Younan R, Baratti D, Costanzo P, Favaro M, Gavazzi C, Deraco M (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(5):1144–1153. https://doi.org/10.1002/cncr.21708
Smeenk RM, Verwaal VJ, Zoetmulder FA (2006) Toxicity and mortality of cytoreduction and intraoperative hyperthermic intraperitoneal chemotherapy in pseudomyxoma peritonei—a report of 103 procedures. Eur J Surg Oncol 32 (2):186- 190. doi:https://doi.org/10.1016/j.ejso.2005.08.009
Elias D, Goere D, Blot F, Billard V, Pocard M, Kohneh-Shahri N, Raynard B (2007) Optimization of hyperthermic intraperitoneal chemotherapy with oxaliplatin plus irinotecan at 43 degrees C after compete cytoreductive surgery: mortality and morbidity in 106 consecutive patients. Ann Surg Oncol 14(6):1818–1824. https://doi.org/10.1245/s10434-007-9348-1
Verhulst J (2013) Hyperthermic intraperitoneal chemoperfusion with high dose oxaliplatin: influence of perfusion temperature on postoperative outcome and survival. F1000Res 2:179. https://doi.org/10.12688/f1000research.2-179.v2
Quenet F, Elias D, Roca L, Goere D, Ghouti L, Pocard M, Facy O, Arvieux C, Lorimier G, Pezet D, Marchal F, Loi V, Meeus P, De Forges H, Stanbury T, Paineau J, Glehen O, UNICANCER-GI Group and the French BIG-Renape Group (2018) A UNICANCER phase III trial of hyperthermic intra-peritoneal chemotherapy (HIPEC) for colorectal peritoneal carcinomatosis (PC): PRODIGE 7. J Clin Oncol 36(18_suppl):LBA3503–LBA3503
Doud AN, Randle RW, Clark CJ, Levine EA, Swett KR, Shen P, Stewart JH, Votanopoulos KI (2015) Impact of distal pancreatectomy on outcomes of peritoneal surface disease treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol 22(5):1645–1650. https://doi.org/10.1245/s10434-014-3976-z
Downs-Canner S, Ding Y, Magge DR, Jones H, Ramalingam L, Zureikat A, Holtzman M, Ahrendt S, Pingpank J, Zeh HJ, Bartlett DL, Choudry HA (2015) A comparative analysis of postoperative pancreatic fistulas after surgery with and without hyperthermic intraperitoneal chemoperfusion. Ann Surg Oncol 22(5):1651–1657. https://doi.org/10.1245/s10434-014-4186-4
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval/informed consent
This study includes anonymized prospectively gathered patients data. Informed consent was obtained from all participants included in this study.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Blaj, S., Nedelcut, S., Mayr, M. et al. Re-operations for early postoperative complications after CRS and HIPEC: indication, timing, procedure, and outcome. Langenbecks Arch Surg 404, 541–546 (2019). https://doi.org/10.1007/s00423-019-01808-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-019-01808-8