Early and long-term postoperative management following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Table 1 Morbidity and mortality rates after cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy

Authors, yr	Patients (n)	PSM	Death (%)	Overall morbid (%)	Major morbid	Most common complications
						1st	2nd	3rd
Jacquet et al[21], 1996	60		5	-	35
Stephens et al[10], 1999	200	Mixed	1.5	-	27	Peripancreatic	Bowel perf/anast leak	Bleeding
Glehen et al[11], 2003	216	Mixed	3.2	30.5	23.6	Bowel perf/anast leak	Haematol	Prolonged ileus
Kusamura et al[14], 2006	209	Mixed	0.9	-	12	Bowel perf/anast leak	Bleeding	Sepsis
Smeenk et al[12], 2006	103	PMP	11	54	54	Infection	Bowel perf/anast leak	Cardiopulm
Gusani et al[15], 2008	124	Mixed	1.6	56.5	29.8	Reoperation	Bowel perf/anast leak	Sepsis
Sugarbaker et al[23], 2006	356	PMP	2.0	74.2	40.2	Haematol	Gastroint	Cardiovasc
Yan et al[24], 2007	70	PM	3.0	41	14	Bleeding	Resp failure	Bowel perf/anast leak
Elias et al[13], 2007	106	Mixed	4	-	66	Bowel perf/anast leak	Lung infection	Haematol
Levine et al[26], 2007	501	Mixed	4.3	43.1	-	-	-	-
Verwaal et al[22], 2004	102	CRC	7.8	65	35	Bowel perf/anast leak	Infection	Haematol
Feldman et al[27], 2003	49	PM	0	38	-	Hepatic	Renal	Haematol
Stewart et al[28], 2006	110	PMP	6	38	-	Wound infection	Haematol	Resp failure

PSM: Peritoneal surface malignancy; PMP: Pseudomyxoma peritonei; PM: Peritoneal mesothelioma; CRC: Colorectal cancer carcinomatosis; perf: Perforation; anast: Anastomoses.

Table 2 Bowel complications associated with cytoreductive surgery and perioperative intra-peritoneal chemotherapy

Authors, yr	Patients (n)	Ratio anast/patient	Protective ostomy (%)	BC/A ratio (%)	Bowel complications rate (%)	Risk factors for bowel complications
Jacquet et al[21], 1996	60	1.8	None	9.3	17	Duration, No. of peritonectomy procedures1
Stephens et al[10], 1999	200	NA	NA	NA	7.5	Intraoperative blood loss1
Witkamp et al[30], 2001	46	2	39	17.4	34
Elias et al[31], 2001	64	2.6	NA	8	18.8
Elias et al[32], 2003	36	2.8	NA	7.2	22.2
Parvaiz et al[33], 2002	43	NA	NA	NA	5
Glehen et al[11], 2003	56	0.6				Carcinomatosis extent, duration, No. of anastomoses1
Glehen et al[34], 2003	73		NA	NA	10.7
Verwaal et al[22], 2004	102	> 2	42	NA	17.6
Shen et al[35], 2004	77	NA	13	NA	NA

¹On univariate analysis. anast: Anastomoses; BC/A: Bowel complications/Anastomoses ratio; NA: Not available.

Table 3 Systemic toxicity after cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy

Authors, yr	Patients (n)	HIPEC drug schedule	EPIC	Severe hematological toxicity (%)	Renal toxicity (%)	Mortality (%)	Risk factor for systemic toxicity
Jacquet et al[21], 1996	60	MMC	60	7	-	5	Not identified
Schnake et al[44], 1999	242	MMC/CDDP	Yes	2.5	-	4	Not identified
Stephens et al[10], 1999	200	MMC	145	4	-	1.5	Not identified
Glehen et al[11], 2003	216	MMC or CDDP or CDDP + MMC	-	4.6	1.3	3.2	NA
Verwaal et al[22], 2004	102	MMC	-	18.6	4.9	8	NA
Shen et al[35], 2004	77	MMC	-	19	-	4	NA
Smeenk et al[12], 2006	103	MMC	-	10.6	-	11	NA
Elias et al[43], 2005	83	Ox + CPT11 + ev 5-FU + AF	-	48	-	4.8	Duration of proc; PCI
Kusamura et al[42], 2007	247	CDDP + MMC or CDDP + Dx	-	5.3	5.7	1.2	CDDP dose > 240 mg; CDDP + Dx schedule for HIPEC

CHT: Chemotherapy; HIPEC: Hyperthermic intraperitoneal chemotherapy; EPIC: Early postoperative intraperitoneal chemotherapy; MMC: Mitomycin-C; Ox: Oxaliplatin; CDDP: Cisplatin; CPT11: Irinotecan; 5-FU: 5-fluorouracil; Dx: Doxorubicin; PCI: Peritoneal Cancer Index.