Bowel complications in 203 cases of peritoneal surface malignancies treated with peritonectomy and closed-technique intraperitoneal hyperthermic perfusion.
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. >or=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 >or=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.
Younan
Rami
R
Department of Surgery, Melanoma and Sarcoma Unit, National Cancer Institute of Milan, Via Venezian, 1, Milan, 20133, Italy.
Kusamura
Shigeki
S
Baratti
Dario
D
Oliva
Grazia Daniela
GD
Costanzo
Pasqualina
P
Favaro
Myriam
M
Gavazzi
Cecilia
C
Deraco
Marcello
M
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use; D010478:Chemotherapy, Cancer, Regional Perfusion; D003106:Colon / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D005743:Gastrectomy; D006801:Humans; D006979:Hyperthermia, Induced; D007410:Intestinal Diseases / Q000209:etiology*; D007412:Intestinal Fistula / Q000209:etiology; D007422:Intestines / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010534:Peritoneal Neoplasms / Q000150:complications* / Q000628:therapy*; D010537:Peritoneum / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors
D000903:Antibiotics, Antineoplastic