Does Intraoperative Systematic Bacterial Sampling During Complete Cytoreductive Surgery (CRS) with Hyperthermic Intraoperative Peritoneal Chemotherapy (HIPEC) Influence Postoperative Treatment? A New Predictive Factor for Postoperative Abdominal Infectious Complications

Autor: Valérie Bridoux, Gregory Wood, Noelle Frebourg, Benoit Veber, Julien Coget, Lilian Schwarz, Emmanuel Huet, Marie Dazza, Jean-Jacques Tuech
Přispěvatelé: Service de chirurgie digestive [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Institute for Research and Innovation in Biomedicine (IRIB), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), UNIROUEN - UFR Santé (UNIROUEN UFR Santé), Normandie Université (NU)-Normandie Université (NU), Service Anesthésie et soins intensifs [CHU Rouen], Nutrition, inflammation et dysfonctionnement de l'axe intestin-cerveau (ADEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de réanimation médicale [CHU Rouen], Hôpital Charles Nicolle [Rouen]-CHU Rouen
Rok vydání: 2016
Předmět:
Adult
Male
medicine.medical_specialty
Blood Loss
Surgical
[SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Risk Factors
Antineoplastic Combined Chemotherapy Protocols
Estimate blood loss
medicine
Humans
Peritoneal Cavity
Survival rate
Digestive System Surgical Procedures
Peritoneal Neoplasms
Aged
Retrospective Studies
Blood Volume
Intraoperative Care
business.industry
Carcinoma
Hazard ratio
Infectious complication
Retrospective cohort study
Cytoreduction Surgical Procedures
Hyperthermia
Induced
Middle Aged
Vascular surgery
Combined Modality Therapy
Peritoneal cancer index
3. Good health
Cardiac surgery
Surgery
Survival Rate
Cardiothoracic surgery
Colorectal resection
030220 oncology & carcinogenesis
Intraabdominal Infections
Female
030211 gastroenterology & hepatology
Hyperthermic intraperitoneal chemotherapy
business
Peritoneal carcinomatosis
Abdominal surgery
Zdroj: World Journal of Surgery
World Journal of Surgery, Springer Verlag, 2016, 40 (12), pp.3035-3043. ⟨10.1007/s00268-016-3635-6⟩
ISSN: 1432-2323
0364-2313
DOI: 10.1007/s00268-016-3635-6
Popis: International audience; BackgroundCytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is an emerging curative treatment option for patients with peritoneal carcinomatosis. It has a long-term survival benefit but is associated with high rates of morbidity, ranging from 12 % to 65 %, mainly due to infectious complications. We sought to evaluate the clinical relevance of routine intraoperative bacteriological sampling following CRS/HIPEC.Study designBetween November 2010 and December 2014, every patients receiving CRS/HIPEC were included. Three samples were routinely collected from standardized locations for intraperitoneal rinsing liquid bacteriological analysis (RLBA) after completion of HIPEC. The clinical and surgical features, bacteriological results, and short-term outcomes were retrospectively reviewed.ResultsThe overall mortality and morbidity rates were 5 and 45 %, respectively. Among the 75 included patients, 40 % (n = 30) had at least one positive bacterial culture. Risk factors for a positive culture were colorectal resection (adjusted hazard ratio [HR] = 3.072, 95 % CI 1.843–8.004; p = 0.009) and blood loss >1000 mL (HR = 4.272, 95 % CI 1.080–18.141; p = 0.031). Among 26 (35 %) patients with abdominal infectious complications, 13 (17 %) experienced isolated complications. A positive RLBA result was independently associated with abdominal infectious complications (HR = 5.108, 95 % CI 1.220–16.336; p = 0.024) and isolated abdominal infectious complications (HR = 4.199, 95 % CI 1.064–15.961; p = 0.04).ConclusionsForty percent of the RLBA samples obtained following CRS/HIPEC tested positive for bacteria. Bacterial sampling of rinsing liquid should be systematically performed. An aggressive and immediate antibiotic strategy needs to be evaluated.
Databáze: OpenAIRE
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