Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Aug 6, 2016; 7(3): 434-439
Published online Aug 6, 2016. doi: 10.4292/wjgpt.v7.i3.434
Incidence of leukopenia after intraperitoneal vs combined intravenous/intraperitoneal chemotherapy in pseudomyxoma peritonei
Philipp Horvath, Stefan Beckert, Florian Struller, Alfred Königsrainer, Ingmar Königsrainer
Philipp Horvath, Stefan Beckert, Florian Struller, Alfred Königsrainer, Ingmar Königsrainer, Department of General, Visceral and Transplant Surgery, University of Tübingen, Comprehensive Cancer Center, 72076 Tübingen, Germany
Author contributions: Horvath P designed and performed the research and wrote the paper; Beckert S performed the statistical analysis and supervised the report; Struller F contributed to the research; Königsrainer A supervised the report; Königsrainer I interpreted the data, supervised the report and made the final revision of the paper.
Institutional review board statement: We confirm that retrospective data collection and dealing with personal data was conducted in accordance to the guidelines of the local ethics committee.
Informed consent statement: We confirm that all patients gave written or oral informed consent prior to their inclusion.
Conflict-of-interest statement: We declare that we have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ingmar Königsrainer, MD, Department of General, Visceral and Transplant Surgery, University of Tübingen, Comprehensive Cancer Center, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany. koenigsrainer@med.uni-tuebingen.de
Telephone: +49-7071-2986620 Fax: +49-7071-295588
Received: February 12, 2016
Peer-review started: February 12, 2016
First decision: March 18, 2016
Revised: March 18, 2016
Accepted: May 10, 2016
Article in press: May 11, 2016
Published online: August 6, 2016
Processing time: 139 Days and 11.1 Hours
Abstract

AIM: To investigate the clinical impact of post-hyperthermic intraperitoneal chemotherapy (HIPEC) leukopenia, intraperitoneal and combined intravenous/intraperitoneal drug administrations were compared.

METHODS: Two patient cohorts were retrospectively analyzed regarding the incidence of postoperative leukopenia. The first cohort (n = 32) received Mitomycin C (MMC)-based HIPEC intraperitoneally (35 mg/m² for 90 min) and the second cohort (n = 10) received a bi-directional therapy consisting of oxaliplatin (OX) (300 mg/m2 for 30 min) intraperitoneally and 5-fluorouracil (5-FU) 400 mg/m² plus folinic acid 20 mg/m² intravenously. The following data were collected retrospectively: Age, sex, length of operation, length of hospital stay, amount of resection including extent of peritonectomy, peritoneal cancer index, CC (completeness of cytoreduction)-status and leukocyte-count before cytoreductive surgery (CRS) and HIPEC, on days 3, 7 and 14 after CRS and HIPEC. HIPEC leukopenia was defined as < 4000 cells/m³.

RESULTS: Leukopenia occurred statistically more often in the MMC than in the OX/5-FU-group (10/32 vs 0/10; P = 0.042). Leukopenia set-on was on day 7 after CRS and MMC-HIPEC and lasted for two to three days. Three patients (33%) required medical treatment. Patients affected by leukopenia were predominantly female (7/10 patients) and older than 50 years (8/10 patients). The length of hospital stay tended to be higher in the MMC-group without reaching statistical significance (22.5 ± 11 vs 16.5 ± 3.5 d). Length of operation (08:54 ± 01:44 vs 09:48 ± 02:28 h) were comparable between patients with and without postoperative leukopenia. Prior history of systemic chemotherapy did not trigger post-HIPEC leukopenia. Occurrence of leucopenia did not trigger surgical site infections, intraabdominal abscess formations, hospital-acquired pneumonia or anastomotic insufficiencies.

CONCLUSION: Surgeons must be aware that there is a higher incidence of postoperative leukopenia in MMC-based HIPEC protocols primarily affecting females and older patients.

Keywords: Pseudomyxoma peritonei; Mitomycin C; Oxaliplatin; Hyperthermic intraperitoneal chemotherapy; Postoperative leukopenia

Core tip: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) are considered the therapy of choice for patients with pseudomyxoma peritonei. Nevertheless this treatment is a major undertaking associated with elevated morbidity. The occurrence of postoperative leukopenia can deteriorate the patient’s outcome by triggering complications like anastomotic insufficiencies or intraabdominal abscess formations so that surgeons must be aware that special patient subsets (primarily older patients and females) exist that are at a higher risk for developing post-HIPEC leukopenia.