Prognostic factors of hemorrhagic complications after oxaliplatin-based hyperthermic intraperitoneal chemotherapy: toward routine preoperative dosage of Von Willebrand factor?

• Published in: European journal of surgical oncology Vol. 43; no. 6; pp. 1095 - 1101
• Main Authors: Delhorme, Jean-Baptiste, MD MSc, Sattler, Laurent, Severac, François, Triki, Elhocine, Gross, Isabelle, Romain, Benoit, Rohr, Serge, Grunebaum, Lélia, Brigand, Cécile
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-06-2017
• Subjects: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Chemotherapy; Colorectal Neoplasms - pathology; Colorectal Neoplasms - therapy; Cytoreduction Surgical Procedures; Epistaxis - epidemiology; Epistaxis - metabolism; Epistaxis - prevention & control; Female; Gastrointestinal Hemorrhage - epidemiology; Gastrointestinal Hemorrhage - metabolism; Gastrointestinal Hemorrhage - prevention & control; Hematology, Oncology and Palliative Medicine; Hemorrhagic complication; HIPEC; Humans; Hyperthermia, Induced - methods; Infusions, Parenteral; Intestinal Neoplasms - pathology; Intestinal Neoplasms - therapy; Male; Middle Aged; Multivariate Analysis; Organoplatinum Compounds - administration & dosage; Oxaliplatin; Peritoneal Diseases - epidemiology; Peritoneal Diseases - metabolism; Peritoneal Diseases - prevention & control; Peritoneal Neoplasms - secondary; Peritoneal Neoplasms - therapy; Postoperative Hemorrhage - epidemiology; Postoperative Hemorrhage - metabolism; Postoperative Hemorrhage - prevention & control; Prognosis; Proportional Hazards Models; Prospective Studies; Surgery; Uterine Neoplasms - pathology; Uterine Neoplasms - therapy; Von Willebrand factor; von Willebrand Factor - metabolism; von Willebrand Factor - therapeutic use; oxaliplatin; HIPEC; hemorrhagic complication; chemotherapy; Von Willebrand factor; Hemorrhagic complication; Chemotherapy; Oxaliplatin
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2017.01.015

Abstract Background Oxaliplatin-based hyperthermic intraperitoneal chemotherapy (HIPEC-ox) induces specific morbidity with hemorrhagic complications (HC). The aim of this study was to identify preoperative, intraoperative and postoperative HC predictive factors after HIPEC-ox. Methods A prospective single center study that included all consecutive patients treated with curative-intent HIPEC-ox, whatever the origin of peritoneal disease, was conducted. All patients underwent systematic blood tests exploring primary hemostasis and endothelial activation before surgical incision (D0) and on postoperative days 2 (POD2) and 5 (POD5). Results Between May 2012 and August 2015, 47 patients were enrolled in the study. The overall HC rate was 38%. Major morbidity was significantly higher in patients with HC. Patients presenting HC were significantly more often affected with pseudomyxoma peritonei and had less preoperative chemotherapy. Multivariate analysis showed that a higher plasmatic level of Von Willebrand factor antigen at D0 (D0 VWF:Ag) was a protective predictive factor for HC (p=0.049, HR: 0.97 CI 95% [0.94-1.00]). A D0 VWF:Ag level below 138% had a sensitivity of 87.5%, a specificity of 67% and an area under the curve of 80.3% (CI 95% [66.5-94], p<0.01) for predicting HC. Conclusions Through the identification of prognostic factors, this study highlighted a subgroup of patients with low risk of HC after HIPEC-ox. Based on these results, we propose a routine preoperative dosage of VWF that would help the surgeon to select the most suitable patients for HIPEC-ox.