Clinical features of pulmonary emboli in patients following cytoreductive surgery (peritonectomy) and hyperthermic intraperitoneal chemotherapy (hipec), a single centre experience

Abstract Background Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) can be complicated by pulmonary emboli (PE). Patients are at high risk due to surgery, underlying malignancy, immobility and indwelling lines. Objectives This paper aims to identify clinically signifi...

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Bibliographic Details
Published in:	European journal of surgical oncology Vol. 41; no. 5; pp. 702 - 706
Main Authors:	Vukadinovic, V, Chiou, J.D, Morris, D.L
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-05-2015
Subjects:	Adult Aged Aged, 80 and over Angiography Antineoplastic Agents - therapeutic use Appendiceal Neoplasms - pathology Chest Pain - etiology Colorectal Neoplasms - pathology Cytoreduction Surgical Procedures Cytoreductive surgery Dyspnea - etiology Female Hematology, Oncology and Palliative Medicine Humans Hyperthermia, Induced Infusions, Parenteral Male Middle Aged Ovarian Neoplasms - pathology Peritoneal Neoplasms - secondary Peritoneal Neoplasms - therapy Peritoneum - surgery Postoperative Complications - diagnostic imaging Postoperative Complications - epidemiology Pulmonary emboli Pulmonary Embolism - complications Pulmonary Embolism - diagnostic imaging Pulmonary Embolism - epidemiology Risk Factors Signs Surgery Symptoms Tomography, X-Ray Computed Young Adult Pulmonary emboli Signs Cytoreductive surgery Symptoms
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Summary:	Abstract Background Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) can be complicated by pulmonary emboli (PE). Patients are at high risk due to surgery, underlying malignancy, immobility and indwelling lines. Objectives This paper aims to identify clinically significant signs and symptoms preceding acute PE in post CRS-HIPEC patients, assess the PE investigative approach in this population and the significance of PE on patient management. Method 25 cases with a positive and 50 controls with a negative CTPA for PE were isolated from the peritonectomy database at St George Hospital Sydney, January 2006 to July 2013. Vital signs, patient symptoms, adjunct investigation findings and patient outcomes were collected and graphed in Microsoft Excel. P values and 95% confidence intervals were calculated using GraphPad Prism version 6. Results 25 of 562 (4.4%) CRS-HIPEC patients were diagnosed with acute PE. Raised body temperature was the only statistically significant clinical finding that differentiated cases from controls ( p value 0.02 ). Arterial blood gas results did not correlate with PE ( p values 0.62; 0.29; 0.55, 0.84 ). Troponin, ECG and CXR were not routinely conducted. CXR and CTPA findings were similar between cases and controls (Table 4). PE patients required lower supplementary oxygen and escalation of care. Conclusion Body temperature is the only statistically significant clinical finding observed with PE. We recommend a standardised investigative approach consisting of troponin, ECG and CXR. PE in CRS-HIPEC does not cause significant cardio-respiratory dysfunction, or escalation of care. PE rates are higher than other major surgeries, thus we propose a trial with increased chemical prophylaxis in CRS-HIPEC patients.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0748-7983 1532-2157
DOI:	10.1016/j.ejso.2015.01.016