Pulmonary Complications following Cytoreductive Surgery and Perioperative Chemotherapy in 147 Consecutive Patients

Abstract

Cytoreductive surgery (CRS) with hyperthermic perioperative chemotherapy (HIPEC) has become a treatment option for selected patients with peritoneal metastases (PMs) from gastrointestinal malignancies. The purpose of this study is to evaluate our most recent data regarding pulmonary complications (respiratory distress, pleural effusion, and pneumonia) and attempt to identify risk factors associated with this management plan. This study includes the most recent 4-year experience with appendiceal and colorectal carcinomatosis patients treated in a uniform manner between January 1, 2006 and December 31, 2009. A prospective morbidity and mortality database was maintained and pulmonary adverse events were analyzed with special attention to subphrenic peritonectomy. There were 147 consecutive patients with a mean age of 49.9 years. Fourteen patients (10%) presented grades I–IV pulmonary complications for a total of 26 events. The peritonectomy of right upper quadrant was performed in 74% and right plus left in 49% of the patients. Statistically, there were no more pulmonary complications among patients submitted to peritoneal stripping of right or right and left hemidiaphragm as compared to no subdiaphragmatic peritonectomy (P = 1.00 and P = 0.58, resp.). In an analysis of 18 quantitative indicators and clinical variables with pulmonary adverse events, only blood replacement greater than six units showed a significant correlation (P = 0.0062). Pulmonary adverse events were observed in 10% of patients having CRS and HIPEC. Subphrenic peritonectomy was not a specific risk factor for developing these adverse events.

Complications of Cytoreductive Surgery and HIPEC in the Treatment of Peritoneal Metastases

“…Several studies have reported the incidence of grade 3/4 pulmonary complications to be in the range of 10-16 % [15,[22][23][24]. As expected, peritonectomy of abdominal diaphragmatic surfaces significantly increases post-operative pleural effusions, particularly in absence of systematic thoracic drainage [25,26].…”

“…As expected, peritonectomy of abdominal diaphragmatic surfaces significantly increases post-operative pleural effusions, particularly in absence of systematic thoracic drainage [25,26]. However, this strategy can reduce but not abolish intrinsic risk of pleural effusion, which remains the second most common pulmonary complications [22].…”

Hyperthermic intraperitoneal chemotherapy enhances blood coagulation perioperatively evaluated by thromboelastography: a pilot study

“…Regarding the conventional coagulation tests previous studies on HIPEC procedure have demonstrated hypocoagulation with possible development of DIC during surgery and the perioperative period [24][25][26][27]. We used P-TT, APTT and platelet count as conventional testing for blood coagulation during CRS.…”

Preliminary Experience and Morbidity Analysis of Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy (CRS/H IPEC ) from a Tertiary Cancer Center in India

“…Similar to us many studies have reported that respiratory complications like effusion, hypoxia, atelectasis and adult respiratory distress syndrome (ARDS) are the second most common adverse events after abdominal complications. Plueral effusion is common to occur after this procedure which could be reactive or due to opening of plueral space during sub-diaphragmatic peritoneal stripping [17]. To circumvent this issue we prophylactically inserted intercostal drain tube whenever diaphragmatic stripping was done.…”