Postoperative bleeding and venous thromboembolism in colorectal cancer patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a systematic review and meta-analysis

Lundbech, Mikkel; Krag, Andreas Engel; Iversen, Lene Hjerrild; Hvas, Anne‐Mette

doi:10.1007/s00384-021-04021-6

Cited by 9 publications

(6 citation statements)

References 68 publications

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“…Oxaliplatin may be preferred in patients with leukopenia and mitomycin in patients with thrombocytopenia ( Levine et al, 2018 ). A meta-analysis that included 3,268 patients found postoperative bleeding incidence rates within 30 days ranged from 1.7% to 8.3%, and venous thromboembolism incidence rates within 90 days ranged from 0.2% to 13.6% after CRS + HIPEC ( Lundbech et al, 2022 ). Thix et al (2009) reported a case of ventricular tachycardia during HIPEC with cisplatin (CP) in a patient with moderate cardiac insufficiency, which may have been caused by high plasma CP levels with concomitant low magnesium levels.…”

Section: Survey Methodologymentioning

confidence: 99%

Side-effects of hyperthermic intraperitoneal chemotherapy in patients with gastrointestinal cancers

Wang

et al. 2023

PeerJ

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Background Hyperthermic intraperitoneal chemotherapy (HIPEC) produces unwanted side-effects that are mainly caused by chemotherapeutic drugs in the treatment of gastrointestinal (GI) cancers, and these effects have not been systematically summarized. The aim of this article was to provide a comprehensive overview of the side-effects of HIPEC for GI cancers and propose practical strategies for adverse event management. Methodology PubMed, Web of Science, and the Cochrane Library were systematically searched for side-effects of HIPEC in GI cancers prior to October 20, 2022. A total of 79 articles were included in this review. Results Adverse events, such as enterocutaneous digestive fistulas, GI tract perforation, neutropenia, postoperative bleeding, ventricular tachycardia, hyperglycemia, hypocalcemia, renal impairment, encapsulating peritoneal sclerosis, scrotal ulceration, and sarcopenia were described, and their clinical management was discussed. These side-effects involve the digestive, hematopoietic, circulatory, metabolic, and urinary systems. Effective methods for adverse event management included an expert multidisciplinary team, replacing chemotherapy drugs, using Chinese medicine, and careful preoperative assessments. Conclusion The side-effects of HIPEC are frequent and can be minimized by several effective methods. This study proposes practical strategies for adverse event management of HIPEC to assist physicians in choosing the optimal treatment method.

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Section: Survey Methodologymentioning

confidence: 99%

Side-effects of hyperthermic intraperitoneal chemotherapy in patients with gastrointestinal cancers

Wang

et al. 2023

PeerJ

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“…This treatment is given in adjunction to cytoreductive surgery in patients with peritoneal carcinomatosis and has been shown to improve 5-year mortality 20 ; however, HIPEC is possibly associated with an aggravated postoperative VTE risk. 21 The next paper in the present issue by Lundbech et al aims to get behind the potential increased VTE risk in HIPEC and reviews the effect of HIPEC on hemostatic activation. 22 The authors conclude that possible mechanisms behind increased VTE risk are an increased acute response, indicated by increased factor VIII and fibrinogen, and possibly impaired fibrinolysis.…”

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confidence: 99%

Cancer-Associated Thrombosis and Beyond: Biomarkers, Treatments, and Cancer-Hemostasis Interactions

Gyldenholm,

Larsen

2024

Semin Thromb Hemost

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“…6,11,12,14 Cancer patients undergoing cytoreductive surgery with HIPEC are at an increased risk for postoperative complications including venous thromboembolism and postoperative bleeding. [15][16][17][18][19][20][21][22][23] The incidence rates for these complications have been reported as high as 13.6% for venous thromboembolism and 8% for postoperative bleeding. [15][16][17][18][19][20][21][22][23] To meet the increased thromboembolic risk, extended thromboprophylaxis is recommended following cytoreductive surgery with HIPEC.…”

mentioning

confidence: 99%

“…[15][16][17][18][19][20][21][22][23] The incidence rates for these complications have been reported as high as 13.6% for venous thromboembolism and 8% for postoperative bleeding. [15][16][17][18][19][20][21][22][23] To meet the increased thromboembolic risk, extended thromboprophylaxis is recommended following cytoreductive surgery with HIPEC. 17,[24][25][26][27] Thrombocytopenia and impaired secondary hemostasis measured by international normalized ratio (INR), activated partial thromboplastin time (aPTT), and fibrinogen have been described within the first five postoperative days following cytoreductive surgery with HIPEC, 16,17,24,28 and perioperative monitoring of coagulation by conventional coagulation markers is the standard procedure in most HIPEC centers.…”

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confidence: 99%

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Changes in Coagulation in Cancer Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy Treatment (HIPEC)—A Systematic Review

Lundbech

Damsbo

Krag

et al. 2023

Semin Thromb Hemost

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Venous thromboembolism and postoperative bleeding are complications of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC). The aim of this systematic review was to summarize current knowledge on the effect of cytoreductive surgery with HIPEC on coagulation and fibrinolysis within 10 days after surgery. Studies were identified in PubMed, Embase, and Web of Science on December 12, 2022. Data on biomarkers of coagulation and fibrinolysis measured preoperatively up to the 10th postoperative day were extracted. Among 15 included studies, 13 studies reported markers of primary hemostasis. Eleven studies found reduced platelet count following cytoreductive surgery with HIPEC and two studies reported reduced platelet function. Twelve studies reported impaired secondary hemostasis until postoperative day 10 indicated by prolonged international normalized ratio, prothrombin time, and activated partial thromboplastin time. Fibrinogen was decreased in three studies from preoperative to postoperative day 3 switching to increased levels until postoperative day 10. In accordance, three studies found reduced maximum amplitude and maximum clot firmness by thromboelastography/thromboelastometry (ROTEM/TEG) on the first postoperative day indicating impaired clot strength. Four studies demonstrated increased d-dimer, factor (F) VIII, and thrombin generation during the 10 postoperative days. Four studies investigated fibrinolysis by ROTEM/TEG and plasminogen activator inhibitor-1 (PAI-1) after cytoreductive surgery with HIPEC reporting contradictive results. In conclusion, a decrease in platelet count and subtle changes in secondary hemostasis were found following cytoreductive surgery with HIPEC. Data on the effect of cytoreductive surgery with HIPEC on fibrinolysis are sparse and this needs to be further investigated.

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Postoperative bleeding and venous thromboembolism in colorectal cancer patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a systematic review and meta-analysis

Cited by 9 publications

References 68 publications

Side-effects of hyperthermic intraperitoneal chemotherapy in patients with gastrointestinal cancers

Side-effects of hyperthermic intraperitoneal chemotherapy in patients with gastrointestinal cancers

Cancer-Associated Thrombosis and Beyond: Biomarkers, Treatments, and Cancer-Hemostasis Interactions

Changes in Coagulation in Cancer Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy Treatment (HIPEC)—A Systematic Review

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