Challenges in surgical management of neutropenic enterocolitis in pediatric cancer patients

Abstract

Neutropenic enterocolitis (NE) affects immunocompromised patients with incidence ranging from 2.6% to 11.6%. The pathogenesis of NE is poorly understood. The recommended treatment is highly controversial, with some suggesting supportive care and others advocating surgery. The present study intended to characterize the outcome, prognostic factors and indications of surgery among those patients PATIENTS AND METHODS This is a retropective cohort observational study conducted during January 2019–2022 on patients aged <18 years with NE. Conservative management was initially started and surgical interventions were done after the failure of conservation. RESULTS Among 5736 patients diagnosed with malignant diseases, 171 patients (3%) developed NE, of them 33 required surgical intervention. Patients with bowel wall thickness <10 mm, isolated drug-resistant organisms, and multifocal distribution were associated with failure of conservative management. deterioration on maximum supportive measures (70%, n = 23), was the most common indication for surgery. The overall 30-day mortality was 18%. The mortality rate in the surgery and conservative arms were 39% and 10% respectively (p = <0.001). Factors associated with higher mortality in all groups were: Drug-resistant blood cultures and multifocal distribution. Vasopressors showed higher mortality in the surgery group (p = 0.003). The bowel wall thickness of >10 mm was associated with higher mortality in the whole (p = 0.001) and conservative groups (p = 0.001). CONCLUSIONS Most patients with NE respond to conservative management. Deterioration in maximum supportive care is the most common indication for surgery. positive blood culture, multifocal distribution, vasopressors and bowel wall thickness of >10 mm were associated with higher mortality.