Incidence of postoperative pancreatic fistula and hyperamylasemia after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
BACKGROUND
The purpose of this study was to analyze the postoperative pancreatic morbidity of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of peritoneal surface malignancies (PSM).


METHODS
Two hundred and sixty five patients (87M/178F) with PSM underwent 270 consecutive procedures. The mean age was 52 years (range: 22-79 years). CRS was performed using peritonectomy procedures. HIPEC through the closed abdomen technique was conducted using cisplatin (CDDP 25 mg/m2/L of perfusate)+mitomycin C (MMC 3.3 mg/m2/L of perfusate) or CDDP (43 mg/L of perfusate)+doxorubicin (Dx 15.25 mg/L of perfusate), at 42.5 degrees C. Diagnosis and classification of postoperative pancreatic fistula (POPF) were performed according to the international study group on pancreatic fistula criteria. Serum amylase alterations were graded according to the National Cancer Institute (NCI) common terminology criteria for adverse events (CTCAE) v3.


RESULTS
POPF was observed in 13 (4.8%) cases. Three cases were classified as major (grade C). Two cases presented postoperative pancreatitis. G3-4 alteration of amylase was observed in 12.3% of the cases. Performing splenectomy and CDDP dosage for HIPEC >240 mg were proven to be independent risk factors for both G3-4 hyperamylasemia and POPF.


CONCLUSIONS
CRS+HIPEC presented an acceptable rate of pancreatic morbidity which did not contribute to the mortality related to the procedure. Most of the POPF were mild and/or easily controlled by conservative measures. Although not specific a normal amylasemia could be a useful marker of pancreatic integrity after CRS+HIPEC.
Kusamura
Shigeki
S
Dept of Surgery, National Cancer Institute of Milan, Milan, Italy.
Baratti
Dario
D
Antonucci
Adelmo
A
Younan
Rami
R
Laterza
Barbara
B
Oliva
Grazia Daniela
GD
Gavazzi
Cecilia
C
Deraco
Marcello
M
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D034321:Hyperamylasemia / Q000209:etiology* / Q000473:pathology; D006979:Hyperthermia, Induced; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D009017:Morbidity; D009364:Neoplasm Recurrence, Local; D010185:Pancreatic Fistula / Q000209:etiology* / Q000473:pathology; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology; D016896:Treatment Outcome
D016685:Mitomycin; D004317:Doxorubicin; D002945:Cisplatin