Postoperative infections after cytoreductive surgery and HIPEC for peritoneal carcinomatosis: proposal and results from a prospective protocol study of prevention, surveillance and treatment.
The incidence of infectious complications due to several contributory causes is particularly elevated and life-threatening in patients undergoing peritonectomy and HIPEC procedure for peritoneal carcinomatosis. Following a previous experience, we started a prospective protocol study of preoperative screening, perioperative prophylaxis and postoperative surveillance and treatment. A total of 111 patients with peritoneal carcinomatosis of various origin underwent CRS with HIPEC between April 2004 and December 2012. The group was divided into a pilot group of 30 patients (04/04 to 05/08) and a main group of 81 patients (06/08 to 12/12). Overall postoperative morbidity rate was 44%, with 35.8% of symptomatic infections. No post-operative mortality was observed. Microorganisms were isolated in 24 patients (80.0%) in the first group and 54 (66.7%) in the second. They were symptomatic in 18 cases (75.0%) and 25 (46.3%) cases respectively. In addition, 7 invasive candidosis were recorded (25.9%). Colon resection (P = 0.01) and duration of surgery (P = 0.0008) were associated with infection at logistic regression model. Concerning symptomatic infections, only Infection Risk Index (P = 0.009) showed significance at multivariate analysis. Despite a significant incidence of infectious complications, establishment of a prevention, surveillance and treatment protocol lead to a zero mortality rate in the observed patients of our experience. Owing to the obtained results, we suggest the use of a standardized protocol for the prevention, monitoring and treatment in all patients enrolled for cytoreductive surgery and HIPEC.
Department of Digestive Surgery, Regina Elena National Cancer Institute, Rome, Italy. Electronic address: valle@ifo.it.
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Valle
Department of Digestive Surgery, Regina Elena National Cancer Institute, Rome, Italy.
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Federici
Department of Digestive Surgery, Regina Elena National Cancer Institute, Rome, Italy.
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Carboni
Department of Infectivology, Regina Elena National Cancer Institute, Rome, Italy.
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Toma
Department of Clinical Pathology and Microbiology, Regina Elena National Cancer Institute, Rome, Italy.
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Gallo
Department of Clinical Pathology and Microbiology, Regina Elena National Cancer Institute, Rome, Italy.
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Prignano
Department of Biostatistic, Regina Elena Cancer Institute, Rome, Italy.
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Giannarelli
Department of Digestive Surgery, Regina Elena National Cancer Institute, Rome, Italy.
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Cenci
Department of Digestive Surgery, Regina Elena National Cancer Institute, Rome, Italy.
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Garofalo
D000293:Adolescent; D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D016470:Bacteremia / Q000209:etiology / Q000628:therapy; D001424:Bacterial Infections / Q000209:etiology* / Q000382:microbiology / Q000517:prevention & control / Q000628:therapy*; D002277:Carcinoma / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods; D002985:Clinical Protocols; D004203:Disinfection / Q000379:methods*; D004322:Drainage; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000209:etiology / Q000628:therapy; D010529:Peritoneal Cavity; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D011159:Population Surveillance; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D011322:Primary Prevention / Q000379:methods*; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000209:etiology / Q000628:therapy; D014552:Urinary Tract Infections / Q000209:etiology / Q000628:therapy
HIPEC; Infection; Peritonectomy