Re-operations for early postoperative complications after CRS and HIPEC: indication, timing, procedure, and outcome

Blaj, Sebastian; Nedelcut, Sebastian; Mayr, Max; Leebmann, Hubert; Leucuţa, Daniel; Glockzin, Gabriel; Piso, Pompiliu

doi:10.1007/s00423-019-01808-8

Cited by 18 publications

(11 citation statements)

References 28 publications

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“…In another German retrospective analysis, the main reasons for reoperation were AI, fascial rupture, and pancreatitis. 34 In our presented data, the total AI rate was 17.9%, namely higher than in recent literature, which suggests AI rates between 8% and 12%. [35][36][37][38][39] These elevated AI rates may also explain the slightly increased reoperation rate.…”

Section: Discussioncontrasting

confidence: 61%

In-Hospital Mortality and Complication Rates According to Health Insurance Data in Patients Undergoing Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Surface Malignancies in Germany

et al. 2020

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Background Morbidity and in-hospital mortality rates of patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in Germany are not known. Methods From 2009 to 2018 all patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in Germany were retrospectively analyzed regarding morbidity and in-hospital mortality rates according to nationwide hospital billing data based on diagnosis-related groups (DRG). The “failure to rescue” (FTR) index, characterizing patients who died after severe but potentially manageable complications, was calculated. Results In total, 8463 patients were included and analyzed. Female sex predominated (1.5:1). Colonic origin of peritoneal metastasis was highest throughout all years, reaching its highest level in 2017 (55%; n = 563) and its lowest level in 2012 (40%; n = 349). Median length of hospital stay reached its maximum in 2017 at 23.9 days and its minimum in 2010 at 22.0 days. Analysis of the total FTR index showed a noticeable improvement over the years, reaching its lowest values in 2017 (9.8%) and 2018 (8.8%). The FTR index for sepsis, peritonitis, and pulmonary complications significantly improved over time. Of the 8463 included patients, 290 died during hospital stay, reflecting an in-hospital mortality rate of 3.4%. Conclusion In-hospital mortality after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is reasonably low compared with other surgical procedures. The improvement in the FTR index reflects efforts to centralize treatment at specialized high-volume centers.

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Section: Discussioncontrasting

confidence: 61%

In-Hospital Mortality and Complication Rates According to Health Insurance Data in Patients Undergoing Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Surface Malignancies in Germany

et al. 2020

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“…In this institution, in agreement with US guidelines [34], Mitomycin C (MMC) was administered intraperitoneally at 42 • C for 90 minutes in the majority (89%) of patients. In the study of 474 consecutive patients treated with CRS and HIPEC over 5 years (2011)(2012)(2013)(2014)(2015) in a high-volume certified PSM reference German center, the re-operation rate was 15% [35].…”

Section: Discussionmentioning

confidence: 99%

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Surface Malignancies: Learning Curve Based on Surgical and Oncological Outcomes

Mielko

Rawicz‐Pruszyński

Sędłak

et al. 2020

Cancers

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“…The mortality rate was 3% in our patient cohort, most likely due to very high tumor burden, previous surgery, and concomitant diseases. The mortality rate reported by the same center was 2.1% in almost 500 consecutive patients, and 2.3% by the German national HIPEC registry after CRS and HIPEC, respectively (42,43).…”

Section: Discussionmentioning

confidence: 89%

Extraperitoneal Approach During Peritonectomy in the Right Upper Quadrant for Peritoneal Metastases from Ovarian Malignancies

Acs

Leebmann

Häusler

et al. 2021

In Vivo

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Aim: To present the extraperitoneal approach for the removal of peritoneal metastases in the right upper abdomen in patients with ovarian cancer and to evaluate safety and potential advantages with comparison with the traditional approach. Patients and Methods: Detailed description of the right upper quadrant peritonectomy as extraperitoneal approach. Procedure-specific short-term complications were retrospectively analyzed in a cohort of patients. Results: Sixty-four patients were included. Fullthickness diaphragmatic resection was performed in 17% of primary cases, and in 44% of the patients with recurrent ovarian carcinoma. The rate of complete cytoreduction (CC-0) was 70%. The most common postoperative complication was pleural effusion (32%). Conclusion: The extraperitoneal approach for peritonectomy of the right upper quadrant in patients with ovarian cancer is feasible, with improved access to the right subdiaphragmatic area. This enables a high rate of complete cytoreduction, and simplified and safe surgical dissection in an uncontaminated area under secured vascular structures. The early postoperative outcomes are comparable to those of the traditional transperitoneal approach.In industrialized countries, ovarian cancer is the leading cause of gynecological cancer-related mortality. The poor prognosis is attributed to the fact that two-thirds of patients have advanced-stage ovarian cancer at diagnosis (1). The majority of these women have extensive intra-abdominal disease with significant peritoneal involvement at the time of diagnosis, resulting in low overall cure rates. The most important prognostic factor remains the residual disease status after cytoreductive surgery (CRS) (2-4).In advanced-stage ovarian cancer, up to 40% of patients present with bulky metastases in the diaphragmatic peritoneal region, mainly on the right side (5-7). Metastases appear in this region as a consequence of transcoelomic tumorous implants from the floating malignant cells in the peritoneal fluid, which circulates clockwise in the peritoneal cavity (8).Maximal effort to achieve complete cytoreduction with the resection of diaphragmatic metastases is associated with improved survival (5,9,10). For this reason, gynecological oncologists commonly perform upper abdominal surgery (9,11). Not only in the primary but also in the recurrent setting, complete cytoreduction seems to deliver survival benefit. Recently results from the DESKTOP III trial, presented at the American Society of Clinical Oncology meeting in Chicago, highlighted a survival benefit in favor of secondary complete CRS in comparison to chemotherapy alone (12).Diaphragmatic peritonectomy and full-thickness resection constitute an effective way to remove diaphragmatic carcinomatosis and achieve complete cytoreduction. These interventions frequently result in intrathoracic and pulmonary complications, although long-term morbidity is uncommon. Diaphragmatic surgery is mostly limited to stripping. However, if the tumor infiltrates the muscle fibers of the diaphragm, ...

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Re-operations for early postoperative complications after CRS and HIPEC: indication, timing, procedure, and outcome

Cited by 18 publications

References 28 publications

In-Hospital Mortality and Complication Rates According to Health Insurance Data in Patients Undergoing Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Surface Malignancies in Germany

In-Hospital Mortality and Complication Rates According to Health Insurance Data in Patients Undergoing Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Surface Malignancies in Germany

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Surface Malignancies: Learning Curve Based on Surgical and Oncological Outcomes

Extraperitoneal Approach During Peritonectomy in the Right Upper Quadrant for Peritoneal Metastases from Ovarian Malignancies

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