Valle M, Federici O, Carboni F, Toma L, Gallo M T, Prignano G, Giannarelli D, Cenci L, Garofalo A
Department of Digestive Surgery, Regina Elena National Cancer Institute, Rome, Italy.
Department of Digestive Surgery, Regina Elena National Cancer Institute, Rome, Italy.
Eur J Surg Oncol. 2014 Aug;40(8):950-6. doi: 10.1016/j.ejso.2013.10.015. Epub 2013 Nov 4.
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.
对于因多种促成因素导致的感染性并发症，在接受腹膜切除术和腹腔热灌注化疗（HIPEC）治疗腹膜癌病的患者中，其发生率特别高且危及生命。根据以往经验，我们启动了一项关于术前筛查、围手术期预防以及术后监测与治疗的前瞻性方案研究。2004年4月至2012年12月期间，共有111例不同来源的腹膜癌病患者接受了细胞减灭术联合HIPEC治疗。该组患者分为一个30例患者的试验组（2004年4月至2008年5月）和一个81例患者的主要组（2008年6月至2012年12月）。总体术后发病率为44%，有症状感染率为35.8%。未观察到术后死亡病例。第一组24例患者（80.0%）和第二组54例患者（66.7%）分离出微生物。它们分别在18例（75.0%）和25例（46.3%）病例中有症状。此外，记录到7例侵袭性念珠菌病（25.9%）。在逻辑回归模型中，结肠切除术（P = 0.01）和手术时长（P = 0.0008）与感染相关。关于有症状感染，在多变量分析中只有感染风险指数（P = 0.009）显示出显著性。尽管感染性并发症发生率较高，但建立预防、监测和治疗方案使我们观察的患者死亡率为零。鉴于所获得的结果，我们建议对所有接受细胞减灭术和HIPEC治疗的患者使用标准化的预防、监测和治疗方案。
