Naffouje Samer A, Salti George I
Department of General Surgery, the University of Illinois at Chicago Hospital and Health Sciences System, Chicago, IL, U.S.A.
Division of Surgical Oncology, the University of Illinois at Chicago Hospital and Health Sciences System, Chicago, IL, U.S.A.
Anticancer Res. 2018 Apr;38(4):2353-2358. doi: 10.21873/anticanres.12482.
As cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are being increasingly adopted as the standard treatment for peritoneal surface malignancies, familiarity with this procedure's adverse events is also growing. Herein, we describe an unreported adverse event of exocrine pancreatic insufficiency (EPI) following CRS and HIPEC.
Patients who underwent CRS and HIPEC between 9/2016 and 9/2017 were prospectively recruited. Fecal elastase-1 (FE1) and Clostridium difficile toxins were tested in all patients in the immediate postoperative period. Patients with diarrhea who had low FE1 were started on oral pancreatic enzyme replacement therapy (PERT) and their symptomatic progression was followed.
A total of 26 patients were included. Eleven patients (42.31%) developed postoperative refractory diarrhea, nine of whom had a low FE1 level. These patients were treated with PERT either directly or after completion of antibiotics course if C. difficile toxin was positive. Eight patients demonstrated symptomatic resolution of their diarrhea, and thus the diagnosis of EPI was established (30.77%). Patients with diarrhea had lower FE1 levels, and were more likely to have had a terminal ileum resection and had a longer hospital stay. Regression analysis identified the rapid rise of a patient's core temperature by >1°C within 15 minutes as the sole predictor of EPI occurrence.
EPI is a potential adverse event following CRS and HIPEC and might be largely responsible for refractory diarrhea. In our patients with refractory diarrhea and low FE1, PERT provided immediate symptomatic relief. The biological basis of this phenomenon remains unclear and warrants further investigation.
随着细胞减灭术（CRS）和腹腔热灌注化疗（HIPEC）越来越多地被用作腹膜表面恶性肿瘤的标准治疗方法，对该手术不良事件的熟悉程度也在增加。在此，我们描述了一例CRS和HIPEC术后未报告的外分泌性胰腺功能不全（EPI）不良事件。
前瞻性招募了2016年9月至2017年9月期间接受CRS和HIPEC的患者。在所有患者术后即刻检测粪便弹性蛋白酶-1（FE1）和艰难梭菌毒素。腹泻且FE1水平低的患者开始口服胰腺酶替代疗法（PERT），并跟踪其症状进展。
共纳入26例患者。11例患者（42.31%）术后出现难治性腹泻，其中9例FE1水平低。如果艰难梭菌毒素呈阳性，这些患者直接接受PERT治疗，或在完成抗生素疗程后接受PERT治疗。8例患者腹泻症状得到缓解，从而确诊为EPI（30.77%）。腹泻患者的FE1水平较低，更有可能接受了回肠末端切除术，且住院时间更长。回归分析确定患者核心体温在15分钟内快速上升>1°C是EPI发生的唯一预测因素。
EPI是CRS和HIPEC术后的潜在不良事件，可能是难治性腹泻的主要原因。在我们难治性腹泻且FE1低的患者中，PERT可立即缓解症状。这一现象的生物学基础仍不清楚，值得进一步研究。
