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Postoperative peritonitis without an underlying digestive fistula after complete cytoreductive surgery plus HIPEC.

Honoré C, Sourrouille I, Suria S, Chalumeau-Lemoine L, Dumont F, Goéré D, Elias D - Saudi J Gastroenterol (2013 Nov-Dec)

Bottom Line: Postoperative mortality was 14%.Five different bacteriological species were identified in intraoperative samples, most frequently Escherichia coli (71%).The infection was monobacterial in 71%, with multidrug resistant germs in 78%.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Oncology, Gustave Roussy, Cancer Center, Villejuif, France.

ABSTRACT

Background/aim: Peritoneal carcinomatosis (PC) is a pernicious event associated with a dismal prognosis. Complete cytoreductive surgery (CCRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is able to yield an important survival benefit but at the price of a risky procedure inducing potentially severe complications. Postoperative peritonitis after abdominal surgery occurs mostly when the digestive lumen and the peritoneum communicate but in rare situation, no underlying digestive fistula can be found. The aim of this study was to report this situation after CCRS plus HIPEC, which has not been described yet and for which the treatment is not yet well defined.

Patients and methods: Between 1994 and 2012, 607 patients underwent CCRS plus HIPEC in our tertiary care center and were retrospectively analyzed.

Results: Among 52 patients (9%) reoperated for postoperative peritonitis, no digestive fistula was found in seven (1%). All had a malignant peritoneal pseudomyxoma with an extensive disease (median Peritoneal Cancer Index: 27). The median interval between surgery and reoperation was 8 days [range: 3-25]. Postoperative mortality was 14%. Five different bacteriological species were identified in intraoperative samples, most frequently Escherichia coli (71%). The infection was monobacterial in 71%, with multidrug resistant germs in 78%.

Conclusions: Postoperative peritonitis without underlying fistula after CCRS plus HIPEC is a rare entity probably related to bacterial translocation, which occurs in patients with extensive peritoneal disease requiring aggressive surgeries. The principles of treatment do not differ from that of other types of postoperative peritonitis.

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Flowchart of the selection of patients with acute postoperative peritonitis after complete cytoreductive surgery (CCRS) plus HIPEC without an underlying digestive fistula
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Figure 1: Flowchart of the selection of patients with acute postoperative peritonitis after complete cytoreductive surgery (CCRS) plus HIPEC without an underlying digestive fistula

Mentions: Among the 607 patients submitted to CCRS plus HIPEC between January 1994 and May 2012 in our tertiary care center, 123 (20%) developed an intra-abdominal complication as listed in Figure 1. Eighty-one patients (13%) required emergency surgery and 52 (9%) were operated on for acute postoperative peritonitis. Among them, no underlying digestive fistula was found in 7 (1%).


Postoperative peritonitis without an underlying digestive fistula after complete cytoreductive surgery plus HIPEC.

Honoré C, Sourrouille I, Suria S, Chalumeau-Lemoine L, Dumont F, Goéré D, Elias D - Saudi J Gastroenterol (2013 Nov-Dec)

Flowchart of the selection of patients with acute postoperative peritonitis after complete cytoreductive surgery (CCRS) plus HIPEC without an underlying digestive fistula
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3958975&req=5

Figure 1: Flowchart of the selection of patients with acute postoperative peritonitis after complete cytoreductive surgery (CCRS) plus HIPEC without an underlying digestive fistula
Mentions: Among the 607 patients submitted to CCRS plus HIPEC between January 1994 and May 2012 in our tertiary care center, 123 (20%) developed an intra-abdominal complication as listed in Figure 1. Eighty-one patients (13%) required emergency surgery and 52 (9%) were operated on for acute postoperative peritonitis. Among them, no underlying digestive fistula was found in 7 (1%).

Bottom Line: Postoperative mortality was 14%.Five different bacteriological species were identified in intraoperative samples, most frequently Escherichia coli (71%).The infection was monobacterial in 71%, with multidrug resistant germs in 78%.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Oncology, Gustave Roussy, Cancer Center, Villejuif, France.

ABSTRACT

Background/aim: Peritoneal carcinomatosis (PC) is a pernicious event associated with a dismal prognosis. Complete cytoreductive surgery (CCRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is able to yield an important survival benefit but at the price of a risky procedure inducing potentially severe complications. Postoperative peritonitis after abdominal surgery occurs mostly when the digestive lumen and the peritoneum communicate but in rare situation, no underlying digestive fistula can be found. The aim of this study was to report this situation after CCRS plus HIPEC, which has not been described yet and for which the treatment is not yet well defined.

Patients and methods: Between 1994 and 2012, 607 patients underwent CCRS plus HIPEC in our tertiary care center and were retrospectively analyzed.

Results: Among 52 patients (9%) reoperated for postoperative peritonitis, no digestive fistula was found in seven (1%). All had a malignant peritoneal pseudomyxoma with an extensive disease (median Peritoneal Cancer Index: 27). The median interval between surgery and reoperation was 8 days [range: 3-25]. Postoperative mortality was 14%. Five different bacteriological species were identified in intraoperative samples, most frequently Escherichia coli (71%). The infection was monobacterial in 71%, with multidrug resistant germs in 78%.

Conclusions: Postoperative peritonitis without underlying fistula after CCRS plus HIPEC is a rare entity probably related to bacterial translocation, which occurs in patients with extensive peritoneal disease requiring aggressive surgeries. The principles of treatment do not differ from that of other types of postoperative peritonitis.

Show MeSH
Related in: MedlinePlus