Postoperative infections after cytoreductive surgery and HIPEC for peritoneal carcinomatosis: Proposal and results from a prospective protocol study of prevention, surveillance and treatment

Valle, Mario; Federici, Orietta; Carboni, Fabio; Toma, Luigi; Gallo, Matteo; Prignano, G.; Giannarelli, Diana; Cenci, L.; Garofalo, Alfredo

doi:10.1016/j.ejso.2013.10.015

Cited by 33 publications

(34 citation statements)

References 18 publications

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“…27 More extensive resections with prolonged operation time and colonic resections also place the patient at an increased risk for postoperative complications like fistulas or infections. 29 Infectious complications are among the most frequent after CRS/HIPEC. 25,[29][30][31] Extensive surgical trauma as well as sepsis lead to a phase of immunosuppression termed compensatory anti-inflammatory response syndrome after an initial proinflammatory state known as systemic inflammatory response syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…29 Infectious complications are among the most frequent after CRS/HIPEC. 25,[29][30][31] Extensive surgical trauma as well as sepsis lead to a phase of immunosuppression termed compensatory anti-inflammatory response syndrome after an initial proinflammatory state known as systemic inflammatory response syndrome. 32,33 Occurrence of complications might therefore disturb the already delicate postoperative immunological balance in these patients, multiplying the postoperative immunosuppressive state.…”

Section: Discussionmentioning

confidence: 99%

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Major Postoperative Complications Are a Risk Factor for Impaired Survival after CRS/HIPEC

2017

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Major Postoperative Complications Are a Risk Factor for Impaired Survival after CRS/HIPEC

2017

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“…As most of the patients in the mortality group suffered from multiple postoperative complications, it is important to note that these complications are intertwined, prolonging the length of hospital stay and increasing the likelihood of patients returning to theatre. In our study, infection and subsequent sepsis remains the most significant cause of hospital death even with the standardized use of 38 A previous study done by Valle et al (2014) reported that the establishment of a prevention, surveillance and treatment protocol led to the early detection of asymptomatic patients with an infection. 38 Early identification of a causative organism and the sensitivity is always a crucial part of effective management of infections.…”

Section: Articlementioning

confidence: 94%

“…In our study, infection and subsequent sepsis remains the most significant cause of hospital death even with the standardized use of 38 A previous study done by Valle et al (2014) reported that the establishment of a prevention, surveillance and treatment protocol led to the early detection of asymptomatic patients with an infection. 38 Early identification of a causative organism and the sensitivity is always a crucial part of effective management of infections. One of our patients was identified to have died from overwhelming sepsis due to an organism (Serratia) that was not sensitive to the antimicrobial agents used.…”

Section: Articlementioning

confidence: 94%

Treatment-related post-operative mortality after cytoreductive surgery and perioperative intraperitoneal chemotherapy

et al. 2017

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Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has an established role in selected patients for the treatment of peritoneal surface malignancy. However, CRS/HIPEC is associated with increased risk of morbidity and mortality. The aim of this review was to identify risk factors for post-operative mortality in an attempt to improve patient outcomes post CRS/HIPEC. This is a retrospective study of prospectively collected data on 1019 patients who underwent CRS/HIPEC by the same surgical team at St George Hospital, Kogarah, Australia, between January 1996 and July 2016.During the 20-year time-period seventeen patients (1.67%) died postoperatively. A higher peritoneal cancer index (PCI), completeness of cytoreduction (CC) score, longer operative time and a volume of intra-operative transfusion were evident in the hospital mortality group and were significantly associated with postoperative mortality on univariate analysis. Postoperative complications including infection, bleeding, pneumonia, fistula, collection and pancreatic leak were also associated with post-operative mortality. The most common cause of death was sepsis (n=15, 88.2%).It is difficult to determine pre-operative factors that can be utilized as predictors of post-operative mortality, as the overall incidence of in-hospital mortality post CRS/HIPEC was very low on our unit. Nevertheless, a cascade of events and learning curve was displayed.

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“…Treatment complications were significantly correlated with the number of Peritonectomy procedures, left diaphragmatic Peritonectomy, duration of surgery and the number of large bowel anastomoses [70] . The global incidence for the 1 th to 4 th degree of gastrointestinal toxicities (according to the Common Terminology Crite ria for Adverse Events) was 17%, and for symptomatic surgical site infections incidence reached 35.85% (with a global morbidity of 45%) [71] . The learning curve must be respected by any medi [35] Single center experience 33 [53] , 34.7 [45] Systematic reviews 13-29 [54] Multi-institutional studies 33 [52] Gastric Randomized clinical trials 11.3 [46] , 11 [47] Pseudomyxoma peritonei…”

Section: Aspectsmentioning

confidence: 99%

Multimodality treatment strategies have changed prognosis of peritoneal metastases

Lungoci

Mironiuc

Muntean

et al. 2016

WJGO

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For a long time, treatment of peritoneal metastases (PM) was mostly palliative and thus, this status was link with "terminal status/despair". The current multimodal treatment strategy, consisting of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), has been strenuously achieved over time, but seems to be the best treatment option for PM patients. As we reviewed the literature data, we could emphasize some milestones and also, controversies in the history of proposed multimodal treatment and thus, outline the philosophy of this approach, which seems to be an unusual one indeed. Initially marked by nihilism and fear, but benefiting from a remarkable joint effort of human and material resources (multi-center and -institutional research), over a period of 30 years, CRS and HIPEC found their place in the treatment of PM. The next 4 years were dedicated to the refinement of the multimodal treatment, by launching research pathways. In selected patients, with requires training, it demonstrated a significant survival results (similar to the Hepatic Metastases treatment), with acceptable risks and costs. The main debates regarding CRS and HIPEC treatment were based on the oncologists' perspective and the small number of randomized clinical trials. It is important to statement the PM patient has the right to be informed of the existence of CRS and HIPEC, as a real treatment resource, the decision being made by multidisciplinary teams. Core tip: The multimodal treatment of peritoneal metastases (PM), involving cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, has been strenuously achieved over time, but seems to be the best treatment option, for selected cases. This paper addresses data about the multimodal treatment strategy, focused to patient's survival, the key indicator for assessing results, in the case of PM. Also, it were highlighted the treatment key aspects and the controversies, high in the 35 years of treatment implementing. By understanding the philosophy of multimodal treatment, physicians will be able to offer an alternative to the routine systemic chemotherapy.Lungoci C, Mironiuc AI, Muntean V, Oniu T, Leebmann H, Mayr M, Piso P. Multimodality treatment strategies have changed prognosis of peritoneal metastases.

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Postoperative infections after cytoreductive surgery and HIPEC for peritoneal carcinomatosis: Proposal and results from a prospective protocol study of prevention, surveillance and treatment

Cited by 33 publications

References 18 publications

Major Postoperative Complications Are a Risk Factor for Impaired Survival after CRS/HIPEC

Major Postoperative Complications Are a Risk Factor for Impaired Survival after CRS/HIPEC

Treatment-related post-operative mortality after cytoreductive surgery and perioperative intraperitoneal chemotherapy

Multimodality treatment strategies have changed prognosis of peritoneal metastases

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