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Table 3 Available literature documenting incidence of gastric perforation following CRS and PIC

From: Gastric perforation following cytoreductive surgery and perioperative intraperitoneal chemotherapy: a case series of six

Reference Study type Aim Number Early or delayed complication Origin HIPEC Mortality from complication Management Suggested possible mechanism
Kusamura et. al. [12] Retrospective observational study To analyse morbidity and mortality of CRS and intraoperative hyperthermic infusion in treatment of peritoneal malignancies 1/209 procedures UCa UC Yes (UC) No Surgical • Partial thickness mechanical and/or thermal damage to visceral surface (aggravated by heated chemotherapy) • Focal heat injury at tip of inflow catheter • Mechanical trauma due to suctioning effect of outflow catheter • Post-operative shrinking of infiltrating metastatic nodules on visceral wall from antiblastic effect of heated chemotherapy
Ceelen et. al. [20] Prospective study To analyse safety and efficacy of HIPEC using high dose oxaliplatin in CRS 1/52 patients UC UC Yes (OX) No Surgical Thermal damage during omentectomy using ultrasonic shears
Zappa et. al. [9] Retrospective observational study To explore the cause and management of gastric perforation following CRS and HIPEC 4/1251 patients Early • 3 appendiceal cancer • 1 ovarian cancer Yes (1—MMC; 2—MMC + DOXc; 1—CDDP No Surgical • Local seromuscular trauma to the greater curvature as a result of traction on the ligated blood vessel and vascular compromise • Damage of stomach wall from direct effects of chemotherapy, which is further amplified by poor perfusion • Nasogastric trauma secondary to suction during postoperative phase
Bhagwandin et. al. [13] Retrospective observational study To analyse incidence of delayed major complications of CRS and HIPEC post-discharge 1/140 procedures Delayed Mesothelioma Yes (cisplatin, DOX) No Endoscopic clipping NRb
Munoz-Casares et. al. [14] Retrospective observational study To analyse long-term outcomes of CRS plus HIPEC 1/218 patients Delayed Ovarian cancer Yes (paclitaxel) No Surgical NR
Martin et. al. [15] Retrospective observational study To identify variables associated with readmission rates following CRS and HIPEC NR Delayed UC Yes (NR) Yes (1 sepsis) NR NR
  1. aUnclear
  2. bNot reported
  3. cDoxorubicin