Infectious Complications after Cytoreductive Surgery and Hyperthermic Intra-Peritoneal Chemotherapy

Surg Infect (Larchmt). Feb/Mar 2017;18(2):157-163. doi: 10.1089/sur.2016.102. Epub 2016 Dec 1.


Background: The aim of this study was to review the post-operative and infectious complications and determine the risk factors associated with infections in cytoreductive surgery (CRS) and hyperthermic intra-peritoneal chemotherapy (HIPEC).

Patients and methods: Between October 2007 and December 2013, patients who underwent CRS and HIPEC with a curative intent were included in the study. The Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance System definitions were used to identify post-operative nosocomial infections.

Results: One hundred and sixty-nine CRS and HIPEC procedures were performed. Overall, 155 complications were observed in 82 (48.5%) patients. Grade 3-4 morbidity rate was 25.5% (n = 43). Seventy infections occurred in 47 patients. Surgical site infection was the most common infectious complication. The most common micro-organism isolated from the cultures was Escherichia coli. Age (odds ratio [OR]1.039, confidence interval [CI] 1.006-1.073), the mean total number of staff scrubbing in the operation(OR 2.241, CI 1.415-3.548), and intensive care unit stay (OR 1.325, CI 0.953-1.842) were independent risk factors for infectious complications.

Conclusions: Infectious complications are the most important cause of peri-operative morbidity and death in CRS and HIPEC. As well as patient and tumor characteristics, surgeon/center-related factors play an important role in infectious morbidity. Patients with peritoneal carcinomatosis should be considered as a complex oncologic group at high risk of infectious complications.

Keywords: hyperthermic intra-peritoneal chemotherapy; infection; morbidity; oncology; peritoneal carcinomatosis.

MeSH terms

  • Antineoplastic Agents / therapeutic use*
  • Cytoreduction Surgical Procedures / adverse effects*
  • Female
  • Humans
  • Hyperthermia, Induced / adverse effects*
  • Male
  • Middle Aged
  • Peritoneal Neoplasms / drug therapy*
  • Peritoneal Neoplasms / epidemiology
  • Peritoneal Neoplasms / surgery*
  • Retrospective Studies
  • Surgical Wound Infection / epidemiology*
  • Surgical Wound Infection / mortality


  • Antineoplastic Agents