title: Hemophagocytic syndrome: an unusual and underestimated complication of cytoreduction surgery with heated intraperitoneal oxaliplatin.
abstract: BACKGROUND
  Hyperthermic intraperitoneal chemotherapy (HIPEC) improves the survival of select patients with peritoneal carcinomatosis. Hemophagocytic syndrome (HS) is a rare and potentially fatal disease. We describe our experience with five patients who developed HS following oxaliplatin HIPEC and propose a management procedure.
  
  
  METHODS
  Hyperthermic intraperitoneal chemotherapy was performed using the open-abdomen technique (43 °C) with oxaliplatin (460 mg/m (2) ) for 30 min. If thrombocytopenia occurred from days 5 to 14, heparin-induced thrombocytopenia was evaluated. For thrombocytopenia with unknown etiology, we performed a bone marrow analysis (BMA). A BMA indicating HS stimulated an extensive infectious disease workup. Herein, we describe "reactive septic HS" and HS of unknown origin.
  
  
  RESULTS
  We documented five patients with HS as a result of severe thrombocytopenia. Underlying infections were present in two patients who were treated with antibiotics and survived. For the remaining three patients, we found no underlying etiology of HS; multidisciplinary staff adapted the clinical management daily. Two patients died on postoperative days 40 and 29. The third patient survived after several operations and treatment with the VAC abdominal dressing system.
  
  
  CONCLUSIONS
  We present these cases to ensure that physicians are aware of the symptoms of HS after HIPEC, which are important for initiating immediate life-saving therapy. This condition is a diagnostic and therapeutic emergency. When HS complicates HIPEC, aggressive, early medical, and surgical management is required. However, the optimal management has not been defined.
authors.affiliation: Department of Digestive Surgery, Hôpital Charles Nicolle, Rouen Cedex, France.
authors.forename: Lilian
authors.initials: L
authors.lastname: Schwarz
authors.forename: Valerie
authors.initials: V
authors.lastname: Bridoux
authors.forename: Benoit
authors.initials: B
authors.lastname: Veber
authors.forename: Eric
authors.initials: E
authors.lastname: Oksenhendler
authors.forename: Vincent
authors.initials: V
authors.lastname: Royon
authors.forename: Francis
authors.initials: F
authors.lastname: Michot
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Tuech
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000473:pathology / Q000628:therapy; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000009:adverse effects*; D003110:Colonic Neoplasms / Q000150:complications* / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects*; D051359:Lymphohistiocytosis, Hemophagocytic / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000009:adverse effects*; D000077150:Oxaliplatin; D010534:Peritoneal Neoplasms / Q000150:complications* / Q000556:secondary / Q000628:therapy; D011183:Postoperative Complications; D011379:Prognosis; D015996:Survival Rate; D013921:Thrombocytopenia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy
chemical_list: D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin