Role of Imaging Studies in Evaluating Patients Post Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Abstract

A 77-year-old male presented to the ED with a new onset of acute abdominal pain, nausea, and vomiting. He had a previous surgical history of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for an appendiceal tumor. Despite the repeated reassuring abdominal examinations, CT abdomen showed high-grade bowel obstruction and perforation. He was urgently taken to the operating room and underwent resection of 70 cm segment of small ischemic bowel with primary anastomosis. His postoperative course was complicated with atrial fibrillation (AF) requiring cardioversion and medical therapy. Later, he was discharged home under stable conditions. Relying on abdominal signs, an abdominal exam in a patient with a previous history of extensive peritonectomy and post-HIPEC surgery is challenging due to the altered peritoneal anatomy. As a result, the abdominal examination findings can be benign and misleading. This can lead to delayed surgical intervention, thereby increasing morbidity and mortality significantly. Therefore, a detailed evaluation with a low threshold for abdominal imaging studies like abdominal X-rays and CT abdomen series is warranted in this subset of patients.

Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy: Analysis of Perioperative Risk Factors and Impact on Outcome

“…Peritoneal carcinomatosis used to be considered a palliative and incurable condition with poor survival rates [1] until 1995, when Sugarbaker et al standardized a surgical approach combined with locoregional chemotherapy, which enabled improvement in quality of life and survival [2]. Over the last decades, cytoreductive surgery (CRS) combined with hyperthermic intraoperative chemotherapy (HIPEC) has evolved as an effective multimodal treatment for selected patients with peritoneal surface malignancies of different origins [3][4][5][6][7]. As any complex procedure, it requires a multidisciplinary and dedicated team and a standard perioperative approach, which includes appropriate patient selection, preoperative optimization, intraoperative protocol, and adequate postoperative care to improve outcomes [8,9].…”