Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center 227 St. Paul Place, 4th Floor Weinberg, Baltimore, MD, 21202-2001, USA.
Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center 227 St. Paul Place, 4th Floor Weinberg, Baltimore, MD, 21202-2001, USA; University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA.
Eur J Surg Oncol. 2021 Sep;47(9):2352-2357. doi: 10.1016/j.ejso.2021.04.002. Epub 2021 Apr 20.
Genital necrosis (GN) is a rare complication of cytoreductive surgery with hyperthermic intraoperative chemotherapy (CRS/HIPEC) which can be confused with necrotizing fasciitis. We present an analysis of GN after CRS/HIPEC to define its natural history.
We identified patients with GN after CRS/HIPEC at two peritoneal surface malignancy institutions. Patient demographic, surgical, and postoperative data were extracted from prospective databases.
Of 1597 CRS/HIPECs performed, 13 patients (0.8%) had GN. The median age was 57 years (IQR: 49-64) and 77% (n = 10) were male. Mitomycin-C was the perfusion agent in all cases of GN (100%). The median time to GN onset after CRS/HIPEC was 64 days (IQR: 60-108) and 2 (15%) patients were receiving systemic chemotherapy at the time of GN onset. Symptoms included severe pain (100%), edema (100%), labial or scrotal skin ulceration (92%), signs of infection (39%), and fever (15%). Seven (54%) patients had thrombocytosis >400 ∗10/L, whereas coagulation tests were within normal reference range in 100% cases. All patients initially underwent conservative treatment, with antibiotic therapy administered in 62% (n = 8). Surgical debridement was performed in 9 (70%) cases with median time after GN onset of 57 (IQR: 8-180).
GN is a debilitating complication after CRS/HIPEC with delayed onset and a protracted clinical course. Optimal treatment results could be achieved with initial conservative management until complete lesion demarcation followed by surgical debridement. The pathophysiology of GN is unclear, and we call for other researchers attention to better understand the complication and prevention.
生殖器坏死（GN）是细胞减灭术联合术中高热化疗（CRS/HIPEC）的一种罕见并发症，可能与坏死性筋膜炎混淆。我们对 CRS/HIPEC 术后 GN 进行了分析，以明确其自然病程。
我们在两家腹膜表面恶性肿瘤机构中确定了 CRS/HIPEC 术后发生 GN 的患者。从前瞻性数据库中提取患者的人口统计学、手术和术后数据。
在 1597 例 CRS/HIPEC 中，有 13 例（0.8%）发生 GN。中位年龄为 57 岁（IQR：49-64），77%（n=10）为男性。所有 GN 病例均使用丝裂霉素-C 作为灌注剂（100%）。CRS/HIPEC 后 GN 发病中位时间为 64 天（IQR：60-108），2 例（15%）患者在 GN 发病时正在接受全身化疗。症状包括严重疼痛（100%）、水肿（100%）、阴唇或阴囊皮肤溃疡（92%）、感染迹象（39%）和发热（15%）。7 例（54%）患者血小板计数>400 ∗10/L，而 100%患者的凝血试验均在正常参考范围内。所有患者最初均接受保守治疗，62%（n=8）给予抗生素治疗。9 例（70%）患者行外科清创术，GN 发病后中位时间为 57（IQR：8-180）。
GN 是 CRS/HIPEC 后的一种严重并发症，发病时间晚，临床病程长。初始保守治疗，直至完全明确病变范围后再行外科清创术，可获得最佳治疗效果。GN 的病理生理学机制尚不清楚，我们呼吁其他研究人员关注，以更好地了解该并发症并进行预防。
