The effect of preoperative immunonutrition intake on postoperative major complications in patients following cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) was assessed. The accuracy of C-Reactive Protein (CRP) for detecting postoperative complications was also analyzed. Patients treated within a peritoneal carcinomatosis program in which a complete or optimal cytoreduction was achieved were retrospectively analyzed. They were divided into two groups based on whether preoperative immunonutrition (IMN) or not (non-IMN) were administered. Clinical and surgical variables and postoperative complications were gathered. Predictive values of major morbidity of CRP during the first 3 postoperative days (POD) were also evaluated. A total of 107 patients were included, 48 belonging to the IMN group and 59 to the non-IMN group. In multivariate analysis immunonutrition (OR 0.247; 95%CI 0.071–0.859; p = 0.028), and the number of visceral resections (OR 1.947; 95%CI 1.086–3.488; p = 0.025) emerged as independent factors associated with postoperative major morbidity. CRP values above 103 mg/L yielded a negative predictive value of 84%. Preoperative intake of immunonutrition was associated with a decrease of postoperative major morbidity and might be recommended to patients with peritoneal carcinomatosis following CRS. Measuring CRP levels during the 3 first postoperative days is useful to rule out major morbidity.

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Introduction Liposarcomas are malignant neoplasms that originate in fatty mesenchymal tissue and are the most common histological subtype of soft tissue sarcomas. They account for 1% of solid tumors in adults and are located mainly in the extremities, with the retroperitoneum being the second most frequent location. Given the rarity and aggressiveness of these tumors, it is advisable to establish a multidisciplinary approach towards them in order to improve the prognosis of patients. Clinical case Patient who was operated upon on a scheduled and outpatient basis for a left inguinal hernia. During surgery, a preperitoneal tumor was identified that was removed and revealed a high-grade dedifferentiated liposarcoma. In a second surgical act, a tumor mass of about 10 centimeters in length was found, lodged in the left pelvis and contacting sigma, which extended into the inguinal duct and scrotal pouch. Finally, compartment surgery and a left orchiectomy with end-to-end colo-sigmoid anastomosis were performed. Discussion Routine examination of the masses contained in the hernial sacs is recommended since, despite their infrequency (<0.1%), cases of liposarcomas that have their origin in the inguinal canal have been described. Surgery for retroperitoneal sarcomas must be compartmental, which requires the inclusion of viscera close to the tumor in the resection. Complete surgical resection R0 is the only potentially curative treatment. Compartment surgery should be performed by expert surgeons in referral centers with multidisciplinary teams to improve the prognosis of these patients.

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