title: Cytoreductive Surgery Combined with Hyperthermic Intraperitoneal Chemotherapy with Oxaliplatin Increases the Risk of Postoperative Hemorrhagic Complications: Analysis of Predictive Factors.
abstract: Treatment of peritoneal carcinomatosis (PC) using cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is recommended as curative treatment for selected patients. Modalities of HIPEC remain heterogeneous and HIPEC using oxaliplatin (HIPEC-Ox) appears to increase the risk of postoperative hemorrhagic complications (HCs).
  
  
  
  The aim of this study was to assess the risk of HCs after CRS combined with HIPEC-Ox versus other drugs, and to determine predictive factors for HCs after HIPEC-Ox.
  
  
  
  Data from 701 patients included in the National French Registry who were treated with CRS and HIPEC at 24 centers between 1998 and 2007 were used to evaluate the incidence of HCs following HIPEC with or without oxaliplatin. Overall, 771 patients treated with HIPEC-Ox at five French specialty centers were then analyzed to determine factors associated with the occurrence of HCs.
  
  
  
  The overall incidence of HCs was 9.8 %. When used with HIPEC, oxaliplatin significantly and independently increased the rate of HCs (15.7 vs. 2.6 % for other drugs; p = 0.004, odds ratio 32.4). Among the 771 patients who underwent HIPEC-Ox, HCs occurred in 14.3 % of patients. The only independent risk factor for HCs was an extended PC with a Peritoneal Cancer Index (PCI) >12 (p = 0.040).
  
  
  
  HIPEC-Ox increases the risk of HCs compared with HIPEC with other drugs. The potential oncologic benefit of oxaliplatin and the risk of HCs should be considered in patients with PC who have a high PCI, as well as in at-risk patients.
authors.affiliation: Department of General Surgery, Centre Hospitalier Lyon Sud, Pierre Bénite, France.|EMR 3738, Lyon 1 University, Lyon, France.
authors.forename: Thibaut
authors.initials: T
authors.lastname: Charrier
authors.affiliation: Department of General Surgery, Centre Hospitalier Lyon Sud, Pierre Bénite, France.|EMR 3738, Lyon 1 University, Lyon, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Passot
authors.affiliation: Department of Biostatistics, UMR 5558, Lyon 1 University, Lyon, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Peron
authors.affiliation: Pôle IMER, Unité de Recherche Clinique, Hospices Civils de Lyon, Lyon, France.
authors.forename: Christelle
authors.initials: C
authors.lastname: Maurice
authors.affiliation: Department of Surgery, Centre Val d'Aurelle, Montpellier, France.
authors.forename: Sashka
authors.initials: S
authors.lastname: Gocevska
authors.affiliation: Department of Surgery, Centre Val d'Aurelle, Montpellier, France.
authors.forename: François
authors.initials: F
authors.lastname: Quénet
authors.affiliation: Department of Surgery, Hôpital Lariboisière, Assistance-Publique, des hôpitaux de Paris, Paris 7 Université Paris Diderot, Paris, France.
authors.forename: Clarisse
authors.initials: C
authors.lastname: Eveno
authors.affiliation: Department of Surgery, Hôpital Lariboisière, Assistance-Publique, des hôpitaux de Paris, Paris 7 Université Paris Diderot, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Pocard
authors.affiliation: Department of Surgery, Gustave Roussy, Cancer Campus, Grand Paris, Paris, France.
authors.forename: Diane
authors.initials: D
authors.lastname: Goere
authors.affiliation: Department of Surgery, Gustave Roussy, Cancer Campus, Grand Paris, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Elias
authors.affiliation: Department of Surgery, Centre Hospitalier Universitaire de Dijon, Dijon, France.
authors.forename: Pablo
authors.initials: P
authors.lastname: Ortega-Deballon
authors.affiliation: Department of General Surgery, Centre Hospitalier Lyon Sud, Pierre Bénite, France.|EMR 3738, Lyon 1 University, Lyon, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Vaudoyer
authors.affiliation: Department of General Surgery, Centre Hospitalier Lyon Sud, Pierre Bénite, France.|EMR 3738, Lyon 1 University, Lyon, France.
authors.forename: Eddy
authors.initials: E
authors.lastname: Cotte
authors.affiliation: Department of General Surgery, Centre Hospitalier Lyon Sud, Pierre Bénite, France. olivier.glehen@chu-lyon.fr.|EMR 3738, Lyon 1 University, Lyon, France. olivier.glehen@chu-lyon.fr.
authors.forename: Olivier
authors.initials: O
authors.lastname: Glehen
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000009:adverse effects*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D010534:Peritoneal Neoplasms / Q000473:pathology / Q000628:therapy*; D011183:Postoperative Complications / Q000209:etiology*; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D016685:Mitomycin; D002945:Cisplatin; D005472:Fluorouracil