title: Clinical features of pulmonary emboli in patients following cytoreductive surgery (peritonectomy) and hyperthermic intraperitoneal chemotherapy (hipec), a single centre experience.
abstract: BACKGROUND
  Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) can be complicated by pulmonary emboli (PE). Patients are at high risk due to surgery, underlying malignancy, immobility and indwelling lines.
  
  
  OBJECTIVE
  This paper aims to identify clinically significant signs and symptoms preceding acute PE in post CRS-HIPEC patients, assess the PE investigative approach in this population and the significance of PE on patient management.
  
  
  METHODS
  25 cases with a positive and 50 controls with a negative CTPA for PE were isolated from the peritonectomy database at St George Hospital Sydney, January 2006 to July 2013. Vital signs, patient symptoms, adjunct investigation findings and patient outcomes were collected and graphed in Microsoft Excel. P values and 95% confidence intervals were calculated using GraphPad Prism version 6.
  
  
  RESULTS
  25 of 562 (4.4%) CRS-HIPEC patients were diagnosed with acute PE. Raised body temperature was the only statistically significant clinical finding that differentiated cases from controls (p value 0.02). Arterial blood gas results did not correlate with PE (p values 0.62; 0.29; 0.55, 0.84). Troponin, ECG and CXR were not routinely conducted. CXR and CTPA findings were similar between cases and controls (Table 4). PE patients required lower supplementary oxygen and escalation of care.
  
  
  CONCLUSIONS
  Body temperature is the only statistically significant clinical finding observed with PE. We recommend a standardised investigative approach consisting of troponin, ECG and CXR. PE in CRS-HIPEC does not cause significant cardio-respiratory dysfunction, or escalation of care. PE rates are higher than other major surgeries, thus we propose a trial with increased chemical prophylaxis in CRS-HIPEC patients.
authors: St George Public Hospital, Gray Street, Kogarah, NSW 2217, Australia. Electronic address: vladana.vuk@gmail.com.
authors: V
authors: V
authors: Vukadinovic
authors: St George Public Hospital, Gray Street, Kogarah, NSW 2217, Australia.
authors: J D
authors: JD
authors: Chiou
authors: St George Public Hospital, Gray Street, Kogarah, NSW 2217, Australia; UNSW Department of Surgery, St George Clinical School, Australia.
authors: D L
authors: DL
authors: Morris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001063:Appendiceal Neoplasms / Q000473:pathology; D002637:Chest Pain / Q000209:etiology; D015179:Colorectal Neoplasms / Q000473:pathology; D065426:Cytoreduction Surgical Procedures; D004417:Dyspnea / Q000209:etiology; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000473:pathology; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000628:therapy*; D010537:Peritoneum / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: Cytoreductive surgery; Pulmonary emboli; Signs; Symptoms