Systemic inflammatory markers for the detection of infectious complications and safe discharge after cytoreductive surgery and HIPEC

INTRODUCTION

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) in patients with ovarian peritoneal carcinomatosis may be associated with a high postoperative morbidity. An early discrimination of postoperative complications is crucial for both improving clinical outcomes and proposing a safe discharge.

MATERIAL AND METHODS

In a cohort of 122 patients with advanced ovarian cancer (FIGO III-IV), we analyzed the diagnostic performance of three systemic inflammatory markers (C-reactive protein, white blood cell count and systemic immune-inflammation index) between the 5th to 8th postoperative days to prediction postoperative infectious complications. An optimal cut-off value was established in order to discriminate between the group of patients who developed infectious complications or not during the postoperative period.

RESULTS

The median peritoneal carcinomatosis index (PCI) was 15. The overall infectious morbidity was 25.4% (31 patients out of 122), of which, 32% (10 patients out of 31) had suffered severe postoperative complications (Dindo-Clavien III-IV). The most accurate results for detecting infectious complications were obtained by using C-reactive protein, which presented an excellent diagnostic performance, especially on the 7th and 8th postoperative days (AUC = 0,857 and 0,920; respectively).

CONCLUSIONS

These results support that it is safe to discharge patients with C-reactive protein concentrations lower than 88 mg/L and 130 mg/L, on the 7th and 8th postoperative days, respectively.

Uterine leiomyosarcoma metastasis to the pancreas: report of a case and review of the literature

INTRODUCTION

Uterine leiomyosarcoma is an aggressive malignant tumor that often leads to metastatic dissemination, generally in the lungs, liver, brain, and bones. Despite the fact that pancreatic neoplasms spread easily, the pancreas is not a usual target organ from other neoplasms.

CASE REPORT

We present a rare case of metastasis to the pancreas from uterine leiomyosarcoma treated with segmental resection with no recurrence at this stage. A review of the literature is later presented showing no similar case to what has been reported.

DISCUSSION

Surgical resection of unique pancreatic metastases is a safe practice. An increase in the survival rate has been demonstrated after resection of metastases from renal cell carcinoma, although it has not been proved with metastases from other locations. Further trials are needed.

Superior mesenteric artery syndrome in a patient with Charcot Marie Tooth disease

The extrinsic compression of the third part of the duodenum as it passes through the aorto-mesenteric angle is known as the superior mesenteric artery syndrome (SMAS). This syndrome is a rare mechanical cause of upper intestinal obstruction, with a reported incidence of between 0.2% and 0.78%. Clinical manifestations of SMAS may be chronic or acute; chronic symptoms include intermittent gastric pain, fullness and occasional episodes of postprandial vomiting, while acute symptoms include incoercible vomiting, oral intolerance, mainly epigastric abdominal distension and abdominal pain. Surgery is recommended only when initial conservative treatment fails. Here, we report what appears to be the third published case of SMAS associated with hereditary motor and sensory neuropathy or Charcot Marie Tooth disease.

[Spontaneous intramural small bowel hemorrhage: an event on the increase]

Spontaneous intramural intestinal hemorrhage is highly infrequent. The most common cause is overdose of oral anticoagulants. Clinical presentation usually consists of abdominal pain and intestinal obstruction. The diagnostic imaging technique of choice is computed tomography. Spontaneous intramural intestinal hemorrhage usually resolves spontaneously and consequently the treatment of choice is non-operative. Surgery is reserved for complicated processes or when the diagnosis is uncertain. We present two cases. The first was due to overanticoagulation by acenocoumarol, and the second was an exceptional complication in a hemophiliac patient.