Gastric Perforation Following Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy: A Case Series of Six

World J Surg Oncol. 2017 Feb 10;15(1):44. doi: 10.1186/s12957-017-1114-7.

Abstract

Background: Incidence of gastric perforation following cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC) is not widely reported.

Methods: Suitable patients were identified from our database of 1028 procedures. Relevant information was then gathered via medical records and operation reports for these patients.

Results: Six patients suffered early postoperative gastric perforation following the procedure (0.58%), all of whom received heated intraoperative intraperitoneal chemotherapy (HIPEC). Surgical exploration revealed protrusion of nasogastric (NG) tube through stomach wall defects which were either located at or near the greater curvature of stomach. These patients were managed successfully with operation, and no mortality was recorded.

Conclusions: Gastric perforation following CRS and PIC is most likely the result of a multifactorial process. To reduce the risk of such complication, avoiding nasogastric suction in these patients may prove helpful. Any suspected perforated viscus must be addressed promptly to avoid unwanted morbidity and mortality from the procedure. To our knowledge, conservative management has not been documented to work in this subgroup and surgery remains the mainstay of treatment.

Keywords: Appendiceal cancer; Gastric perforation; HIPEC; Heated intraoperative intraperitoneal chemotherapy; Nasogastric tube; Peritonectomy; Stomach; Suction.

MeSH terms

  • Adult
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects*
  • Chemotherapy, Cancer, Regional Perfusion / adverse effects*
  • Combined Modality Therapy
  • Female
  • Follow-Up Studies
  • Humans
  • Hypothermia, Induced / adverse effects*
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Ovarian Neoplasms / pathology
  • Ovarian Neoplasms / therapy
  • Peritoneal Neoplasms / secondary
  • Peritoneal Neoplasms / therapy*
  • Prognosis
  • Prospective Studies
  • Retrospective Studies
  • Stomach Rupture / etiology*
  • Stomach Rupture / pathology