title: Postoperative peritonitis without an underlying digestive fistula after complete cytoreductive surgery plus HIPEC.
abstract: OBJECTIVE
  Peritoneal carcinomatosis (PC) is a pernicious event associated with a dismal prognosis. Complete cytoreductive surgery (CCRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is able to yield an important survival benefit but at the price of a risky procedure inducing potentially severe complications. Postoperative peritonitis after abdominal surgery occurs mostly when the digestive lumen and the peritoneum communicate but in rare situation, no underlying digestive fistula can be found. The aim of this study was to report this situation after CCRS plus HIPEC, which has not been described yet and for which the treatment is not yet well defined.
  
  
  METHODS
  Between 1994 and 2012, 607 patients underwent CCRS plus HIPEC in our tertiary care center and were retrospectively analyzed.
  
  
  RESULTS
  Among 52 patients (9%) reoperated for postoperative peritonitis, no digestive fistula was found in seven (1%). All had a malignant peritoneal pseudomyxoma with an extensive disease (median Peritoneal Cancer Index: 27). The median interval between surgery and reoperation was 8 days [range: 3-25]. Postoperative mortality was 14%. Five different bacteriological species were identified in intraoperative samples, most frequently Escherichia coli (71%). The infection was monobacterial in 71%, with multidrug resistant germs in 78%.
  
  
  CONCLUSIONS
  Postoperative peritonitis without underlying fistula after CCRS plus HIPEC is a rare entity probably related to bacterial translocation, which occurs in patients with extensive peritoneal disease requiring aggressive surgeries. The principles of treatment do not differ from that of other types of postoperative peritonitis.
authors.affiliation: Department of Surgical Oncology, Gustave Roussy, Cancer Center, Villejuif, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Honoré
authors.forename: Isabelle
authors.initials: I
authors.lastname: Sourrouille
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Suria
authors.forename: Ludivine
authors.initials: L
authors.lastname: Chalumeau-Lemoine
authors.forename: Frédéric
authors.initials: F
authors.lastname: Dumont
authors.forename: Diane
authors.initials: D
authors.lastname: Goéré
authors.forename: Dominique
authors.initials: D
authors.lastname: Elias
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D003452:Cryosurgery / Q000009:adverse effects*; D016154:Digestive System Fistula; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000628:therapy*; D010538:Peritonitis / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D011183:Postoperative Complications; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents