title: Gastric perforation following cytoreductive surgery and perioperative intraperitoneal chemotherapy: a case series of six.
abstract: BACKGROUND
  Incidence of gastric perforation following cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC) is not widely reported.
  
  
  METHODS
  Suitable patients were identified from our database of 1028 procedures. Relevant information was then gathered via medical records and operation reports for these patients.
  
  
  RESULTS
  Six patients suffered early postoperative gastric perforation following the procedure (0.58%), all of whom received heated intraoperative intraperitoneal chemotherapy (HIPEC). Surgical exploration revealed protrusion of nasogastric (NG) tube through stomach wall defects which were either located at or near the greater curvature of stomach. These patients were managed successfully with operation, and no mortality was recorded.
  
  
  CONCLUSIONS
  Gastric perforation following CRS and PIC is most likely the result of a multifactorial process. To reduce the risk of such complication, avoiding nasogastric suction in these patients may prove helpful. Any suspected perforated viscus must be addressed promptly to avoid unwanted morbidity and mortality from the procedure. To our knowledge, conservative management has not been documented to work in this subgroup and surgery remains the mainstay of treatment.
authors.affiliation: Department of Surgery, St. George Hospital, University of New South Wales, Sydney, New South Wales, Australia. frank.ls01@hotmail.com.
authors.forename: Lee S
authors.initials: LS
authors.lastname: Kyang
authors.affiliation: Department of Surgery, St. George Hospital, University of New South Wales, Sydney, New South Wales, Australia.|Imam Muhammad ibn Saud Islamic University College of Medicine, Riyadh, Saudi Arabia.
authors.forename: Nayef A
authors.initials: NA
authors.lastname: Alzahrani
authors.affiliation: Department of Surgery, St. George Hospital, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Jing
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Department of Surgery, St. George Hospital, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: David L
authors.initials: DL
authors.lastname: Morris
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000009:adverse effects*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000473:pathology / Q000628:therapy; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D013275:Stomach Rupture / Q000209:etiology* / Q000473:pathology
keywords: Appendiceal cancer; Gastric perforation; HIPEC; Heated intraoperative intraperitoneal chemotherapy; Nasogastric tube; Peritonectomy; Stomach; Suction