Akademik Veri Yönetim Sistemi
The 12th International Congress on Peritoneal Surface Malignancies, Beijing, Çin, 10 - 12 Ekim 2021, ss.271-272
Background:
Urgent
re-laparotomy(URL) can be accepted as an important index of quality indicator
in cytoreductive surgery(CRS) and hyperthermic intraperitoneal
chemotherapy(HIPEC). Complications after CRS are usually associated with
shortened survival, early recurrence of primary tumor, exhaustion of center’s
sources, and high costs. However, reports of URL tend to be scarce, very limited,
and fragmented.
Objectives:
To
evaluate/determine the morbi-mortality outcomes of the urgent re-laparotomized
patients treated with CRS and HIPEC.
Methods:
Prospectively
maintained database of 661 patients treated with potentially curative intent of
CRS&HIPEC in years of 2007 and 2020 were evaluated. URL was done for 28
patients as planned re-exploration(4.2%): 22(78.6%) of them was female. The
median age was 57 year (ranging, 24 to 76). There were 22(78.6%) patients over
65 years old. Sixty-four(n=18) percent of the URL patients were received
neoadjuvant chemotherapy. All standart clinico-pathological characteristics,
re-operative findings, and final outcomes were analyzed. The well-known
immunoscores such as neutrophile-lymphocyte(N/L), neutrophile-thrombocyte (N/T),
and CRP-albumin ratios(CAR) were determined.
Results: The
main indication for URL was small bowel anastomotic leak(n=13; 46.4%). The
abdominal wall disruption(n=5; 17.9%) was the second indication. The frequent
localization of damaged organ was again small bowel. The 28.6% of patients(n=8)
were re-operated in early postoperative period(in 7 days), whileas the rest of
them [71.4%(n=20)] in 90 days. There was only one re-URL patient in this
series. Many of them(n=16; 57.1%) had more than one co-morbidities. Delving
into the overall group, there were Dindo-Clavien(D-C) grade I-II complications
in 104(16.4%) patients and D-C grade III-IV in 88(13.9%) patients, whereas in
URL patient group, D-C grade III-IV complications were seen in 22(78.6%). In
this prospective cohort, the mortality rate was 3.2%(n=20) without any
re-exploration. However, six(21.4%) patients were also lost in URL patients.
The main reason for failure-to-rescue was sepsis due to entero-enteral
anastomotic leak. In four of them, multiple co-morbidities were affected the
post-URL care. Fifty percent of mortal patients had neoadjuvant chemotherapy.
The cut-off PCI scores of URL, saved-URL, and lost-URL patients were 13, 14,
and 12, respectively. CC-0 score was detected in 23 URL patients in whom four
of them were lost, whileas CC-1 in 5 in whom two of them were lost. For
URL-patients, pre-urgent re-laparotomy median N/L, N/T, and CAR values were
9.12(ranging, 1.72 to 37.5), 0.03(ranging, 0.01 to 0.12), and 41.4(ranging, 4.2
to 181.3), respectively. Interestingly, N/L and CAR values(4.71 and 28.8)
estimated before pre-CRS were also significantly higher(p=.01 and p<.01)in
patients who were going to be treated with URL. These immunoscore values did
not show any association in between pre-CRS and pre-URL mortal patients.
Conclusions:
The
judgemental factors at work were complex in even planned URL. The overall
survival depends almost entirely on the severity of disease. Patients with high
risk factors could be selected to an intense care postoperatively for close
monitoring. Timely intervention and proper management strategy are utmost important
issues to lower further morbi-mortality in patients treated with URL.