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Incidence of Postoperative Pancreatic Fistula and Hyperamylasemia after Cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy

¹ Dept of Surgery, National Cancer Institute of Milan, Milan, Italy
² Nutritional Care Unit, National Cancer Institute of Milan, Milan, Italy
³ Dept of Surgery – Surgical Oncology Unit, CHUM, University of Montreal Health Centre, Montreal, Canada
⁴ Istituto Nazionale Tumori Milano, Via Venezian 1, 20133, Milano, Italia

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

Introduction: The purpose of this study was to analyze the postoperative pancreatic morbidity of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of peritoneal surface malignancies (PSM).

Patients and methods: Two hundred and sixty five patients (87M/178F) with PSM underwent 270 consecutive procedures. The mean age was 52 years (range: 22–79 years). CRS was performed using peritonectomy procedures. HIPEC through the closed abdomen technique was conducted using cisplatin (CDDP 25mg/m2/L of perfusate)+mitomycin C (MMC 3.3 mg/m2/L of perfusate) or CDDP (43mg/L of perfusate)+doxorubicin (Dx 15.25 mg/L of perfusate), at 42.5° C. Diagnosis and classification of postoperative pancreatic fistula (POPF) were performed according to the international study group on pancreatic fistula criteria. Serum amylase alterations were graded according to the National Cancer Institute (NCI) common terminology criteria for adverse events (CTCAE) v3.

Results: POPF was observed in 13 (4.8%) cases. Three cases were classified as major (grade C). Two cases presented postoperative pancreatitis. G3-4 alteration of amylase was observed in 12.3% of the cases. Performing splenectomy and CDDP dosage for HIPEC >240mg were proven to be independent risk factors for both G3-4 hyperamylasemia and POPF.

Conclusions: CRS+HIPEC presented an acceptable rate of pancreatic morbidity which did not contribute to the mortality related to the procedure. Most of the POPF were mild and/or easily controlled by conservative measures. Although not specific a normal amylasemia could be a useful marker of pancreatic integrity after CRS+HIPEC.

Key Words: Peritonectomy • hyperthermic intraperitoneal chemotherapy • Toxicity