Abstract 1839P
Background
The intraoperative administration of Hyperthermic Intraperitoneal Chemotherapy is a novel treatment strategy that tries to provide similar therapeutic effects while avoiding some of the limitations of traditional treatment. The purpose of this analysis is to systemically review the available clinical studies to determine the infection rates postoperatively as complication of HIPEC with CRS procedure. As there are currently evolving guidelines for clinical application of this intervention this study helps in evaluating the safety of combined CRS and HIPEC for rates of infection.
Methods
A detailed comprehensive search for all relevant studies was conducted through PubMed, MEDLINE and Google scholar using search words as (((“Cytoreduction Surgical Procedures/adverse effects”[Mesh]) AND “Hyperthermic Intraperitoneal Chemotherapy/adverse effects”[Mesh]) AND “Infections”[Mesh]) AND “Neoplasms”[Mesh]. Extracted data was analysed using Rev Man software and random effect model using self-designed tables.
Results
Out of 41 studies included, 24 were retrospective, while 17 were prospective studies. These studies matriculated a total of 10303 procedures of CRS with HIPEC; out of which, 2704 (26.24%) episodes of infections were observed while no infection was noted in 7675 (74.49%) procedures. Random effect model was used for outcome analysis which showed significant heterogeneity (I2 = 97%) but overall effect size was significant (p<0.00001). The funnel plot of infection vs no infection was asymmetrical on visual inspection. Risk ratio was 0.37 (0.30, 0.49) for development of infectious complications. The most common infections were SSI (1075, 39.8%) followed by sepsis (519, 19.2%). Mortality rate was recorded in 35 (out of 41)studies and found highest (42.1%) in study by Elgendy et al. Increased stay in hospital was reported, (minimum 1 – maximum 177 days) in patients developing infections.
Conclusions
CRS with HIPEC is a safe and effective treatment procedure under trained supervision, with no increased risk of infection. Infectious complications can be effectively managed with a multi-disciplinary approach involving oncosurgeons and infectious disease specialists for optimal patient outcomes. As a result of the possible survival advantages CRS and HIPEC provide, it would be prudent to study the complications associated with this novel surgical technique in an appropriately designed prospective study.
Clinical trial identification
Editorial acknowledgement
Scientific editing was provided by Dr. Rima Shah (MD Pharmacology), Assistant professor in Department of Pharmacology, GMERS Medical College, Gandhinagar, India.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.