Predicting and managing intra-abdominal collections by image guided percutaneous drainage after cytoreductive surgery and hyperthermic intra peritoneal chemotherapy: A five-year experience with 1313 patients

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso Pub Date : 2025-02-01 DOI:10.1016/j.ejso.2024.109495

Ahmed Saeed, Camran Nesari, Victoria Evans, Kandiah Chandrakumaran, Thomas Desmond Cecil, Brendan John Moran, Faheez Mohamed

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引用次数: 0

Abstract

Introduction

Intraabdominal collections (IACs) are common following cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Inflammatory biomarkers and nutritional index (NI) may predict IACs. Management of IACs with image guided percutaneous drainage (IGPD) is an alternative to laparotomy.

Aim

To identify factors that predict IACs following CRS and HIPEC and to review outcomes following IGPD.

Method

A retrospective review of prospectively collected data from a national referral centre including patients undergoing CRS and HIPEC who developed IACs treated with IGPD, between January 2018 and March 2022. Propensity score matched cases were compared to evaluate the prediction of IACs. The outcomes of IGPD were reviewed.

Results

Intraabdominal collections developed in 106 (8.0 %) of 1313 patients and 101/106 underwent IGPD, under Ultrasound or CT guidance. Laparotomy was required in 5/106.

In those undergoing IGPD, pre- and postoperative CRP and neutrophils were significantly elevated while pre- and postoperative albumin and NI were significantly lower than propensity score matched controls. The postoperative CRP and neutrophil count, and pre and postoperative albumin and mGPS were identified as independent predictors in multivariable analysis.

IGPD improved clinical condition in 94 %. In 15/106(14.8 %) the aetiology of the IAC was anastomotic leak with left subphrenic collections the most common (24/101, 24 %). There were 4 major complications, 2 perforations of bladder during IGPD insertion and 2 post drain removal bleeds.

Conclusion

Intraabdominal collections following CRS and HIPEC can be predicted by inflammatory markers and nutritional index. Prompt use of IGPD results in good outcomes avoiding the need for laparotomy.

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通过图像引导下经皮引流预测和管理细胞减少手术和腹膜内高温化疗后的腹腔内收集：1313例患者的5年经验。

简介：腹腔内收集（IACs）是细胞减缩手术（CRS）和腹腔内高温化疗（HIPEC）后常见的现象。炎症生物标志物和营养指数（NI）可以预测IACs。影像引导下经皮引流（IGPD）是治疗IACs的一种替代方法。目的：确定预测CRS和HIPEC后IACs的因素，并回顾IGPD后的结果。方法：回顾性分析2018年1月至2022年3月期间，从国家转诊中心前瞻性收集的数据，包括接受CRS和HIPEC治疗并接受IGPD治疗的IACs患者。比较倾向评分匹配的病例，评估IACs的预测。回顾了IGPD的成果。结果：1313例患者中有106例（8.0%）出现腹腔积液，101/106行IGPD，在超声或CT引导下。5/106需要剖腹手术。在接受IGPD的患者中，术前和术后CRP和中性粒细胞显著升高，而术前和术后白蛋白和NI显著低于倾向评分匹配的对照组。在多变量分析中，术后CRP和中性粒细胞计数以及术前和术后白蛋白和mGPS被确定为独立预测因子。IGPD改善了94%的临床状况。15/106（14.8%）的IAC病因为吻合口漏，最常见的是左膈下积液（24/101,24%）。主要并发症4例，IGPD置入期间膀胱穿孔2例，引流后出血2例。结论：CRS和HIPEC术后腹腔内收集物可通过炎症标志物和营养指数进行预测。及时使用IGPD可获得良好的结果，避免了剖腹手术的需要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Ejso 医学-外科

CiteScore

6.40

自引率

2.60%

发文量

1148

审稿时长

41 days

期刊介绍： JSO - European Journal of Surgical Oncology ("the Journal of Cancer Surgery") is the Official Journal of the European Society of Surgical Oncology and BASO ~ the Association for Cancer Surgery. The EJSO aims to advance surgical oncology research and practice through the publication of original research articles, review articles, editorials, debates and correspondence.