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