Postoperative paralytic ileus after cytoreductive surgery combined with heated intraperitoneal chemotherapy.

Jesper Nors,Jonas Amstrup Funder,Brendan John Moran,Søren Laurberg,David Richard Swain,Tom Cecil,Victor Jilbert Verwaal

doi:10.1515/pp-2019-0026

Abstract

BackgroundPatients with peritoneal malignancy treated by cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) are prone to develop postoperative paralytic ileus (POI). POI is associated with significant increase in both morbidity and mortality. CRS and HIPEC commonly result in prolonged POI (PPOI). The objective was to clarify the extent of PPOI in patients treated by CRS and HIPEC for peritoneal malignancy.MethodsThis was a prospective multicenter study including patients operated with CRS and HIPEC at the Department of Surgery, Aarhus University Hospital, Denmark and the Peritoneal Malignancy Institute, Basingstoke, United Kingdom. A total of 85 patients were included over 5 months. Patients prospectively reported parameters of postoperative gastrointestinal function in a diary from post-operative day 1 (POD1) until discharge. PPOI was defined as first defecation on POD6 or later.ResultsMedian time to first flatus passage was 4 days (range 1–12). Median time to first defecation was 6 days (1–14). Median time to removal of nasojejunal tube was 4 days (3–13) and 7 days (1–43) for nasogastric tube. Forty-six patients (54%) developed PPOI. Patients with PPOI had longer time to first flatus (p<0.0001) and longer time to removal of nasojejunal tube (p=0.001). Duration of surgery correlated to time to first flatus (p=0.015) and time to removal of nasogastric or nasojejunal tube (p<0.0001) but not to time to first defecation (p=0.321).ConclusionsPostoperative gastrointestinal paralysis remains a common and serious problem in patients treated with CRS and HIPEC.

Highlights

The aim of cytoreductive surgery (CRS) is to remove all macroscopic malignant tumor and combine the surgery with intra-operative hyperthermic intraperitoneal chemotherapy (HIPEC) [1, 2]
Six or seven regions estimated by the Simplified Peritoneal Cancer (SPC) Score [21] led to exclusion for all diseases except pseudomyxoma peritonei (PMP) where more extensive disease was allowed
Complete cytoreduction was achieved in 82 patients (96%) and HIPEC was performed in all patients

Summary

Introduction

The aim of cytoreductive surgery (CRS) is to remove all macroscopic malignant tumor and combine the surgery with intra-operative hyperthermic intraperitoneal chemotherapy (HIPEC) [1, 2]. CRS involves extensive intraabdominal surgery rendering patients prone to develop paralytic postoperative ileus (POI) [8,9,10,11,12,13]. Patients with peritoneal malignancy treated by cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) are prone to develop postoperative paralytic ileus (POI). Methods: This was a prospective multicenter study including patients operated with CRS and HIPEC at the Department of Surgery, Aarhus University Hospital, Denmark and the Peritoneal Malignancy Institute, Basingstoke, United Kingdom. Results: Median time to first flatus passage was 4 days (range 1–12). Median time to removal of nasojejunal tube was 4 days (3–13) and 7 days (1–43) for nasogastric tube

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