Bowel Complications in 203 Cases of Peritoneal Surface Malignancies Treated With Peritonectomy and Closed-Technique Intraperitoneal Hyperthermic Perfusion (original) (raw)

Abstract

Background

Peritonectomy and intraperitoneal hyperthermic perfusion (IPHP) are increasingly used in the management of carcinomatosis of various sites of origin. We analyzed the risk factors for bowel complications with primary anastomoses and the closed technique for IPHP.

Methods

From 1995 to 2004, 203 consecutive procedures were performed at the National Cancer Institute of Milan. We retrospectively analyzed this series of patients. Treated pathologies included peritoneal mesothelioma; pseudomyxoma peritonei; colorectal, ovarian, or gastric carcinomatosis; and abdominal sarcomatosis. All digestive anastomoses were performed before the IPHP. Only one defunctioning stoma was used.

Results

We found a bowel complication rate of 10.8%. The bowel complications:anastomoses ratio was 11.3%. On univariate analysis we found a statistically significant association between bowel complications and the following variables: sex, previous systemic chemotherapy status, number of anastomoses ( fewer than two vs. two or more), duration of the procedure (<8.7 vs. ≥8.7 hours), and extent of cytoreduction. After multivariate analysis, male sex (odds ratio [OR], 4.2), no previous systemic chemotherapy (OR, 3.5), and duration of the procedure ≥8.7 hours (OR, 6.3) were considered independent risk factors for bowel complications.

Conclusions

Bowel complications are not increased when primary unprotected anastomoses are performed during peritonectomy and IPHP when the closed technique is used. Male sex, duration of the procedure, and no previous systemic chemotherapy are independent unfavorable risk factors.

Access this article

Log in via an institution

Subscribe and save

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Verwaal VJ, van Ruth S, de Bree E, et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol 2003;21:3737–43
    Article Google Scholar
  2. Bayo’n LG, Sugarbaker PH, Moreno SG, Vazquez L, Alves S, Moran BJ. Initiation of a program in peritoneal surface malignancy. Surg Oncol Clin North Am 2003;12:741–53
    Article Google Scholar
  3. Moran BJ, Cecil TD. The etiology, clinical presentation, and management of pseudomyxoma peritonei. Surg Oncol Clin North Am 2003;12:585–603
    Article Google Scholar
  4. Sugarbaker PH, Ronnett BM, Archer A, et al. Pseudomyxoma peritonei syndrome. Adv Surg 1997;30:233–80
    Google Scholar
  5. Verwaal VJ, van Tinteren H, Ruth SV, Zoetmulder FA. Toxicity of cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy. J Surg Oncol 2004;85:61–7
    Article Google Scholar
  6. Elias D, Blot F, El Otmany A, et al. Curative treatment of peritoneal carcinomatosis arising from colorectal cancer by complete resection and intraperitoneal chemotherapy. Cancer 2001;92:71–6
    Article Google Scholar
  7. Glehen O, Osinsky D, Cotte E, et al. Intraperitoneal chemohyperthermia using a closed abdominal procedure and cytoreductive surgery for the treatment of peritoneal carcinomatosis: morbidity and mortality analysis of 216 consecutive procedures. Ann Surg Oncol 2003;10:863–9
    Article Google Scholar
  8. Witkamp AJ, de Bree E, Kaag MM, van Slooten GW, van Coevorden F, Zoetmulder FA. Extensive surgical cytoreduction and intraoperative hyperthermic intraperitoneal chemotherapy in patients with pseudomyxoma peritonei. Br J Surg 2001;88:458–63
    Article Google Scholar
  9. Elias D, Matsuhisa T, Sideris L, et al. Heated intra-operative intraperitoneal oxaliplatin plus irinotecan after complete resection of peritoneal carcinomatosis: pharmacokinetics, tissue distribution and tolerance. Ann Oncol 2004;15:1558–65
    Article Google Scholar
  10. Sugarbaker PH. Peritonectomy procedures. Surg Oncol Clin North Am 2003;12:703–27
    Article Google Scholar
  11. Japanese Research Society for Gastric Cancer. The general rules for the gastric cancer study in surgery and pathology. Jpn J Surg 1981;11:127–39
    Google Scholar
  12. Fujimoto S, Takahashi M, Kobayashi K, et al. Combined treatment of pelvic exenterative surgery and intra-operative pelvic hyperthermochemotherapy for locally advanced rectosigmoid cancer: report of a case. Surg Today 1993;23:1094–8
    Article Google Scholar
  13. Rossi CR, Foletto M, Mocellin S, et al. Hyperthermic intraoperative intraperitoneal chemotherapy with cisplatin and doxorubicin in patients who undergo cytoreductive surgery for peritoneal carcinomatosis and sarcomatosis: phase I study. Cancer 2002;94:492–9
    Article Google Scholar
  14. Sugarbaker PH. Peritonectomy procedures. Ann Surg 1995;221:29–42
    Google Scholar
  15. Jacquet P, Stephens AD, Averbach AM, et al. Analysis of morbidity and mortality in 60 patients with peritoneal carcinomatosis treated by cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy. Cancer 1996;77:2622–9
    Article Google Scholar
  16. Stephens AD, Alderman R, Chang D, et al. Morbidity and mortality analysis of 200 treatments with cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy using the coliseum technique. Ann Surg Oncol 1999;6:790–6
    Article Google Scholar
  17. Elias D, Laurent S, Antoun S, et al. Pseudomyxoma peritonei treated with complete resection and immediate intraperitoneal chemotherapy. Gastroenterol Clin Biol 2003;27:407–12
    Google Scholar
  18. Parvaiz A, Amin AI, Howell R, Sexton R, Moran BJ. First one hundred referrals, predominantly of pseudomyxoma peritonei, to a peritoneal surface malignancy unit: operability and early outcome. Br J Surg2002;89(Suppl 1):13
    Article Google Scholar
  19. Glehen O, Mithieux F, Osinsky D, et al. Surgery combined with peritonectomy procedures and intraperitoneal chemohyperthermia in abdominal cancers with peritoneal carcinomatosis: a phase II study. J Clin Oncol 2003;21:799–806
    Article Google Scholar
  20. Glehen O, Cotte E, Schreiber V, Sayag-Beaujard AC, Vignal J, Gilly FN. Intraperitoneal chemohyperthermia and attempted cytoreductive surgery in patients with peritoneal carcinomatosis of colorectal origin. Br J Surg 2004;91:747–54
    Article Google Scholar
  21. Shen P, Hawksworth J, Lovato J, et al. Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy with mitomycin C for peritoneal carcinomatosis from nonappendiceal colorectal carcinoma. Ann Surg Oncol 2004;11:178–86
    Article Google Scholar
  22. Murio JE, Sugarbaker PH. Gastrointestinal fistula following cytoreductive procedures for peritoneal carcinomatosis: incidence and outcome. J Exp Clin Cancer Res 1993;12:3.
    Google Scholar
  23. Sarnaik AA, Sussman JJ, Ahmad SA, Lowy AM. Technology of intraperitoneal chemotherapy administration: a survey of techniques with a review of morbidity and mortality. Surg Oncol Clin North Am 2003;12:849–63
    Article Google Scholar
  24. Elias D, Antoun S, Goharin A, Otmany AE, Puizilout JM, Lasser P. Research on the best chemohyperthermia technique of treatment of peritoneal carcinomatosis after complete resection. Int J Surg Investig 2000;1:431–9
    Google Scholar
  25. Kuzu M, Koksoy C, Kale T, Demirpence E, Renda N. Experimental study of the effect of preoperative 5-fluorouracil on the integrity of colon anastomosis. Br J Surg 1998;85:236–9
    Article Google Scholar
  26. Fumagalli U, Trabucchi E, Soligo M, et al. Effects of intraperitoneal chemotherapy on anastomotic healing in rats. J Surg Res 1991;50:82–7
    Article Google Scholar
  27. Arikan AY, Gunal O, Pehlivan M, Alper M. The effect of intraperitoneal paclitaxel administration on colonic anastomosis. Hepatogastroenterology 2000;47:1273–6
    Google Scholar
  28. Shimizu T, Maeta M, Koga S. Influence of local hyperthermia on the healing of small intestinal anastomoses in the rat. Br J Surg 1991;78:57–9
    Google Scholar
  29. Kusamura S, Deraco M, Baratti D, et al. Cytoreductive surgery followed by intra peritoneal hyperthermic perfusion in the treatment of peritoneal surface malignancies: morbidity and mortality with closed abdomen technique. J Exp Clin Cancer Res 2003;22(Suppl):4
    Google Scholar
  30. Deraco M, Rossi CR, Pennacchioli E, et al. Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion in the treatment of recurrent epithelial ovarian cancer: a phase II clinical study. Tumori 2001;87:120–6
    Google Scholar
  31. Zanon C, Clara R, Bortolini M, et al. Chemohyperthermia for advanced abdominal malignancies: a new procedure with closed abdomen and previously performed anastomosis. Int J Hyperthermia 2001;17:456–64
    Article Google Scholar

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Melanoma and Sarcoma Unit, National Cancer Institute of Milan, Via Venezian, 1, Milan, 20133, Italy
    Rami Younan MD, Shigeki Kusamura MD, Dario Baratti MD, Grazia Daniela Oliva MD & Marcello Deraco MD
  2. Department of Surgery, Surgical Oncology Unit, Centre Hospitalier de l’Université de Montreal, University of Montreal Health Center, Montreal, Canada
    Rami Younan MD
  3. Department of Obstetrics and Gynecology, School of Medical Science, Universidade Estadual de Campinas, Campinas, Brazil
    Shigeki Kusamura MD
  4. Unit of Emergency Surgery and Organ Transplant, Università degli Studi di Messina, Policlinico G. Martino, Messina, Italy
    Grazia Daniela Oliva MD
  5. Department of Anesthesiology, National Cancer Institute of Milan, Via Venezian, 1, Milan, 20133, Italy
    Pasqualina Costanzo MD
  6. Department of Critical Care, National Cancer Institute of Milan, Via Venezian, 1, Milan, 20133, Italy
    Myriam Favaro MD
  7. Nutritional Care Unit, National Cancer Institute of Milan, Via Venezian, 1, Milan, 20133, Italy
    Cecilia Gavazzi MD

Authors

  1. Rami Younan MD
    You can also search for this author inPubMed Google Scholar
  2. Shigeki Kusamura MD
    You can also search for this author inPubMed Google Scholar
  3. Dario Baratti MD
    You can also search for this author inPubMed Google Scholar
  4. Grazia Daniela Oliva MD
    You can also search for this author inPubMed Google Scholar
  5. Pasqualina Costanzo MD
    You can also search for this author inPubMed Google Scholar
  6. Myriam Favaro MD
    You can also search for this author inPubMed Google Scholar
  7. Cecilia Gavazzi MD
    You can also search for this author inPubMed Google Scholar
  8. Marcello Deraco MD
    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence toMarcello Deraco MD.

Rights and permissions

About this article

Cite this article

Younan, R., Kusamura, S., Baratti, D. et al. Bowel Complications in 203 Cases of Peritoneal Surface Malignancies Treated With Peritonectomy and Closed-Technique Intraperitoneal Hyperthermic Perfusion.Ann Surg Oncol 12, 910–918 (2005). https://doi.org/10.1245/ASO.2005.11.030

Download citation

Keywords