Postoperative complications and critical care management after cytoreduction surgery and hyperthermic intraperitoneal chemotherapy: A systematic review of the literature

Table 1 Demographic details and disease load

Ref.	Data duration	Type of Cohort/Study	No of Institutes (Country)	PSM	No of procedures	Age		PCI
Cavaliere et al[35], 2011	1995-2007	Prospective	Five (Italy)	Colorectal	146	56 (19-76)	median (range)	< 11-48, 11-20-72, > 20-26	Range
Glehen et al[36], 2010	1989-2007	Retrospective	Twenty-five (Europe and Canada)	Non-ovarian	1154, 190(EPIC)	52 (12)	mean (SD)	13.1 (8.9)	mean (SD)
Cooksley et al[7], 2011	2009-2010	Retrospective	Single (England)	Mixed	69	53.3 (30-73)	mean (range)	10.5	Mean
Mizumoto et al[37], 2012	2007-2011	Retrospective	Single (Japan)	Mixed	284	57 (13) (23–88)	mean (SD) (range)	20 (13) (0–39)	mean (SD) (range)
Bakrin et al[1], 2012	1991-2008	Retrospective	Two (France)	Ovarian	246	57.5 (28.6-77.6)	Mean (range)	10.8 (1-31)	Mean (range)
Baratti et al[17], 2012	1995-2011	Prospective	Single (Italy)	Mixed	426	53.4 (12.7)	mean (SD)	18.7 (10.8)	mean (SD)
Bakrin et al[16], 2013	1991-2010	Retrospective	Thirteen (France)	Ovarian	566	57.89 (22-77)	Median (range)	8.5 (0-31)	Median (range)
Canda et al[27], 2013	2007-2012	Retrospective	Single (Turkey)	Mixed	118	53.4 (20-82)	Mean (range)	14.7 (3-28)	Mean (range)
Jafari et al[15], 2014	2005-2011	Retrospective	> 500 (USA)	Mixed	694	55 (10)	mean (SD)	NA
Levine et al[30], 2014	1991-2013	Prospective	Single (USA)	Mixed	1000	52.9 (12.4)	mean (SD)	12	Mean
Cascales-Campos et al[24], 2016	2008-2014	Prospective	Single (Spain)	Mixed	156	57 (33-79)	Median (range)	8 (0-13)	Median (range)
Martin et al[25], 2016	1991-2014	Retrospective	Single (USA)	Mixed	302	54% (40-60)	Percent (range)	13 (6-18)	Median (IQR)
Elekonawo et al[38], 2019	2010-2015	Case matched RCT	Two centres in Netherlands	Colorectal	223	61.4(10.7)	mean (SD)	9.0 (0–24)	Median (range)
Kelly et al[39], 2018	2007-2014	Retrospective	Single (USA)	Mixed	226	53 (20-66)	Median (range)	14 (0-27)	Median (range)

RCT: Randomised controlled trial; PCI: Peritoneal carcinomatosis index; EPIC: Early postoperative intravenous chemotherapy; SD: Standard Deviation; PSM: Peritoneal surface malignancies; NA: Not available.

Table 2 Surgical complications

Ref.	N	Mortality (%)	Days	Morbidity (Grade III/IV), %	Complication classification	Commonest complications			Re-operations (%)
						First (%)	Second (%)	Third (%)
Cavaliere et al[35], 2011	146	2.7	30	27.4	WHO	GI perforation/anastomotic leak (7.4)	Sepsis (4.1)	Pancreatitis/pancreatic fistula (1.4)	NA
Glehen et al[36], 2010	1154, 190 (EPIC)	4.1	30	33.6	NCICTCAE	GI perforation/anastomotic leak (9.7)	Pneumonia (9.1)	Intraabdominal bleeding (7.7)	14
Cooksley et al[7], 2011	69	0	30	5.79	NA	Pneumonia (2.9)	Central line infection (1.5)	Uncontrolled hypertension (1.5)	NA
Mizumoto et al[37], 2012	284	3.5	30	17	NCICTCAE	GI perforation/anastomotic leak (6.7)	Sepsis (4.6)	Intraabdominal bleeding (2.1)	11
Bakrin et al[1], 2012	246	0.37	30	11.6	NCICTCAE	GI perforation/anastomotic leak (4.9)	Intraabdominal bleeding (2.4)		4.9
Baratti et al[17], 2012	426	2.6	90	25.3	NCICTCAE	GI perforation/anastomotic leak (11.03)	Sepsis (3.76)	Intraabdominal bleeding (3.3)	10.7
Bakrin et al[16], 2013	566	0.8	30	31.3	NCICTCAE	Intraabdominal bleeding (8)	GI perforation/anastomotic leak (3)		8
Canda et al[27], 2013	118	7.6	30	31.35	NCICTCAE	Sepsis (7.6)	Pneumonia (2.5)	Ileus (2.5)	5.08
Jafari et al[15], 2014	694	2.3	30	32.9	NA	Intraabdominal bleeding (17)	Sepsis (15.9)	Pneumonia (4.8)	9.8
Levine et al[30], 2014	1000	3.8	30	42	NA	Sepsis	GI perforation/anastomotic leak	Pneumonia	NA
Cascales-Campos et al[24], 2016	156	0.6	30	11.5	NCICTCAE	Pleural effusion (4.49)	Sepsis (3.8)	GI perforation/anastomotic leak (1.9)	NA
Martin et al[25], 2016	302	3	30		NA	Pleural effusion (10.8)	Thrombosis (6.8)	Sepsis (5.4)	NA
Elekonawo et al[38], 2019	223	1.5	30	17.6	Clavien Dindo	Sepsis (14.7)	GI perforation/anastomotic leak		NA
Kelly et al[39], 2018	226		30	NA	NA	Ileus (31)	Sepsis (21)	Thrombosis (15)	16

EPIC: Early postoperative intravenous chemotherapy; GI: Gastrointestinal; NA: Not available; NCICTCAE: National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0 (NCICTCAE).

Table 3 Systemic toxicities due to chemotherapy

Ref.	HIPEC drugs	EPIC	Nephrotoxicity, %	Haematological toxicity, %
Glehen et al[36], 2010	MMC + CDDP/Ox + 5FU/leucovorin	MMC+5FU	1	13.3
Bakrin et al[1], 2012	CDDP + MMC/DX			3
Baratti et al[17], 2012	CDDP + MMC/DX		5.4	5.9
Bakrin et al[16], 2013	CDDP/MMC/DX		11	11
Canda et al[27], 2013	CDDP + /MMC		25.8	19.8
Jafari et al[15], 2014	NA		3.7	0

EPIC: Early postoperative chemotherapy; HIPEC: Hyperthermic intraperitoneal chemotherapy; MMC: Mitomycin-C; CDDP-Cisplatin, 5FU” % flurouracil; Ox: Oxaloplatin; Dx: Adriamycin.