Postoperative infections after cytoreductive surgery and HIPEC for peritoneal carcinomatosis: Proposal and results from a prospective protocol study of prevention, surveillance and treatment
Postoperative infections after cytoreductive surgery and HIPEC for peritoneal carcinomatosis: Proposal and results from a prospective protocol study of prevention, surveillance and treatment
复制标题
DOI：
10.1016/j.ejso.2013.10.015
复制
发表时间：
2014-08-01
期刊：
影响因子：
3.8
通讯作者：
Garofalo, A.
中科院分区：
文献类型：
--
作者：
Valle, M.;Federici, O.;Garofalo, A.
在因腹膜癌病而接受腹膜切除术和HIPEC手术的患者中，由几种促成原因引起的感染并发症的发生率特别高，并危及生命。2004年4月至2012年12月，我们对111例不同来源的腹膜癌转移患者采用HIPEC行CRS治疗。该组分为30例患者（2004年4月至2008年5月）的试验组和81例患者（2008年6月至2012年12月）的主要组。总体术后发病率为44%，其中35.8%为症状性感染。未观察到术后死亡。在第一组的24名患者（80.0%）和第二组的54名患者（66.7%）中分离出微生物。有症状者分别为18例（75.0%）和25例（46.3%）。此外，还记录了7例侵袭性念珠菌病（25.9%）。Logistic回归模型显示，结肠切除（P = 0.01）和手术持续时间（P = 0.0008）与感染相关。关于症状性感染，只有感染风险指数（P = 0.009）在多变量分析中显示出显著性。尽管感染并发症的发生率很高，但在我们的经验中，建立预防、监测和治疗方案导致观察患者的死亡率为零。由于所获得的结果，我们建议使用一个标准化的协议，预防，监测和治疗的所有患者入组细胞减灭术和HTPEC。(C)2013爱思唯尔有限公司保留所有权利。
The incidence of infectious complications due to several contributory causes is particularly elevated and life-threatening in patients undergoing peritonectomy and HIPEC procedure for peritoneal carcinomatosis. Following a previous experience, we started a prospective protocol study of preoperative screening, perioperative prophylaxis and postoperative surveillance and treatment.A total of 111 patients with peritoneal carcinomatosis of various origin underwent CRS with HIPEC between April 2004 and December 2012. The group was divided into a pilot group of 30 patients (04/04 to 05/08) and a main group of 81 patients (06/08 to 12/12). Overall postoperative morbidity rate was 44%, with 35.8% of symptomatic infections. No post-operative mortality was observed. Microorganisms were isolated in 24 patients (80.0%) in the first group and 54 (66.7%) in the second. They were symptomatic in 18 cases (75.0%) and 25 (46.3%) cases respectively. In addition, 7 invasive candidosis were recorded (25.9%). Colon resection (P = 0.01) and duration of surgery (P = 0.0008) were associated with infection at logistic regression model. Concerning symptomatic infections, only Infection Risk Index (P = 0.009) showed significance at multivariate analysis.Despite a significant incidence of infectious complications, establishment of a prevention, surveillance and treatment protocol lead to a zero mortality rate in the observed patients of our experience. Owing to the obtained results, we suggest the use of a standardized protocol for the prevention, monitoring and treatment in all patients enrolled for cytoreductive surgery and HTPEC. (C) 2013 Elsevier Ltd. All rights reserved.