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Bowel Complications in 203 Cases of Peritoneal Surface Malignancies Treated With Peritonectomy and Closed-Technique Intraperitoneal Hyperthermic Perfusion

¹ Department of Surgery, Melanoma and Sarcoma Unit, National Cancer Institute of Milan, Via Venezian, 1, 20133 Milan, Italy
² Department of Surgery, Surgical Oncology Unit, Centre Hospitalier de l’Université de Montreal, University of Montreal Health Center, Montreal, Canada
³ Department of Obstetrics and Gynecology, School of Medical Science, Universidade Estadual de Campinas, Campinas, Brazil
⁴ Unit of Emergency Surgery and Organ Transplant, Università degli Studi di Messina, Policlinico G. Martino, Messina, Italy
⁵ Department of Anesthesiology, National Cancer Institute of Milan, Via Venezian, 1, 20133 Milan, Italy
⁶ Department of Critical Care, National Cancer Institute of Milan, Via Venezian, 1, 20133 Milan, Italy
⁷ Nutritional Care Unit, National Cancer Institute of Milan, Via Venezian, 1, 20133 Milan, Italy

Correspondence: Address correspondence and reprint requests to: Marcello Deraco, MD; E-mail: marcello.deraco{at}istitutotumori.mi.it

Background: Peritonectomy and intraperitoneal hyperthermic perfusion (IPHP) are increasingly used in the management of carcinomatosis of various sites of origin. We analyzed the risk factors for bowel complications with primary anastomoses and the closed technique for IPHP.

Methods: From 1995 to 2004, 203 consecutive procedures were performed at the National Cancer Institute of Milan. We retrospectively analyzed this series of patients. Treated pathologies included peritoneal mesothelioma; pseudomyxoma peritonei; colorectal, ovarian, or gastric carcinomatosis; and abdominal sarcomatosis. All digestive anastomoses were performed before the IPHP. Only one defunctioning stoma was used.

Results: We found a bowel complication rate of 10.8%. The bowel complications:anastomoses ratio was 11.3%. On univariate analysis we found a statistically significant association between bowel complications and the following variables: sex, previous systemic chemotherapy status, number of anastomoses ( fewer than two vs. two or more), duration of the procedure (<8.7 vs. 8.7 hours), and extent of cytoreduction. After multivariate analysis, male sex (odds ratio [OR], 4.2), no previous systemic chemotherapy (OR, 3.5), and duration of the procedure 8.7 hours (OR, 6.3) were considered independent risk factors for bowel complications.

Conclusions: Bowel complications are not increased when primary unprotected anastomoses are performed during peritonectomy and IPHP when the closed technique is used. Male sex, duration of the procedure, and no previous systemic chemotherapy are independent unfavorable risk factors.

Key Words: Peritoneal carcinomatosis • Peritonectomy • Intraperitoneal hyperthermic perfusion • Intestinal complications

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