title: Digestive fistulas after cytoreductive surgery & HIPEC in peritoneal carcinomatosis.
abstract: OBJECTIVE
  The development of digestice fistulas is a complication of gastrointestinal operations during cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). In this article we present the incidence, management and outcome of enterocutaneous digestive fistulas after CRS and HIPEC.
  
  
  METHODS
  Over the past 10 years (2005-2014), 184 patients with peritoneal carcinomatosis underwent CRS and HIPEC. HIPEC was administered in the operating room immediately after CRS, but in 48 (26%) patients this happened before the formation of intestinal anastomosis or repair of seromuscular tears, using the open (coliseum) technique; in the remaining 137 (74%) patients the anastomoses were performed before HIPEC. All patients were operated on by the same surgical team.
  
  
  RESULTS
  Of the 185 patients 16 (8.6%) developed an enterocutaneous digestive fistula. Spontaneous fistula closure was observed in 14 (87.5%) patients. The median duration of spontaneous closure was 18 days (range 9-56). Reoperation was needed in 2 (12.5%) patients. There were 2 (12.5%) deaths.
  
  
  CONCLUSIONS
  CRS and HIPEC is a well-known treatment modality for peritoneal carcinomatosis. The incidence of digestive fistulas is increased a little compared to that of conventional digestive surgery.
authors.affiliation: International Institute for the Management of Peritoneal Surface Malignancy, Athens, Greece.
authors.forename: Evgenia
authors.initials: E
authors.lastname: Halkia
authors.forename: Elias
authors.initials: E
authors.lastname: Efstathiou
authors.forename: Athanassios
authors.initials: A
authors.lastname: Rogdakis
authors.forename: Christos
authors.initials: C
authors.lastname: Christakis
authors.forename: John
authors.initials: J
authors.lastname: Spiliotis
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures / Q000009:adverse effects*; D016154:Digestive System Fistula / Q000209:etiology*; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects*; D007274:Injections, Intraperitoneal; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents