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Intraperitoneal Photodynamic Therapy Causes a Capillary-Leak Syndrome

From the Departments of Surgery (RJC, SBK, DJR, FRS, DLF), Biostatistics and Epidemiology (RM), and Radiation Oncology (JMM, EJG, SMH), University of Pennsylvania, Philadelphia, Pennsylvania.

Correspondence: Address correspondence and reprint requests to: Douglas L. Fraker, MD, Division of Surgical Oncology, Department of Surgery, University of Pennsylvania Medical Center, 3400 Spruce Street, 4 Silverstein, Philadelphia, PA 19104; Fax: 215-662-3629; E-mail: frakerd{at}uphs.upenn.edu

ABSTRACT

Background: In patients undergoing intraperitoneal (IP) photodynamic therapy (PDT), the combination of aggressive surgical debulking and light therapy causes an apparent systemic capillary-leak syndrome that necessitates significant intensive care unit (ICU) management after surgery.

Methods: From May 1997 to May 2001, 65 patients underwent surgical debulking and PDT as part of an ongoing phase II trial for disseminated IP cancer. Perioperative data were reviewed retrospectively, and statistical analyses were performed to determine whether any identifiable factors were associated with the need for mechanical ventilation for longer than 1 day and with the occurrence of postoperative complications.

Results: Forty-three women and 22 men (mean age, 49 years) were treated. Operative time averaged 9.8 hours, and mean estimated blood loss was 1450 mL. The mean crystalloid requirement for the first 48 hours after surgery was 29.3 L, and 49 patients required blood products. Twenty-four patients were intubated for longer than 24 hours, with a mean of 8.3 days for those intubated longer than 1 day. The median ICU stay was 4 days. Overall, 110 complications developed in 45 (69%) of the 65 patients. Significant complications included 6 patients with acute respiratory distress syndrome, 28 patients with infectious complications, and 4 patients with anastomotic complications. Statistical analyses revealed that surgery-related factors were significantly associated with these complication outcomes.

Conclusions: Patients who undergo surgical debulking and IP PDT develop a significant capillary-leak syndrome after surgery that necessitates massive volume resuscitation, careful ICU monitoring, and, frequently, prolonged ventilatory support.

Key Words: Photodynamic therapy • Carcinomatosis • Sarcomatosis • Capillary-leak syndrome

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