Ricerc@Sapienza

Background. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy
(HIPEC) showed promising results in selected patients. High morbidity restrains its wide
application. The aim of this study was to report postoperative infectious complications and
investigate possible correlations with preoperative nutritional status and other prognostic factors in
patients with peritoneal metastases treated with CRS and HIPEC.
Methods. For the study we reviewed the clinical records of all patients with peritoneal metastases
from different primary cancers and treated by CRS and HIPEC in our Institution from November
2000 to December 2017. Patients were divided according to their nutritional status (SGA) in group
A (well-nourished), B/C (mild or severely malnourished). Possible statistical correlations between
risk factors and postoperative complications rates have been investigated by univariate and
multivariate analysis.
Results. Two hundred patients were selected and underwent CRS and HIPEC during the study
period. Postoperative complications occurred in 44% of the patients, 35.3% in SGA-A patients and
53% in SGA-B /C patients. Cause of complications was infective in 42, non-infective in 37 and
HIPEC related in 9 patients. Infectious complications occurred more frequently in SGA-B /C
patients (32.6% vs. 9.8% of SGA-A patients). The most frequent sites of infection were Surgical
Site Infections (SSI, 35.7%) and Central Line Associated BloodStream Infections (CLABSI,
26.2%). The most frequent isolated species was Candida (22.8%). ASA score, blood loss,
performance status, PCI, large bowel resection, postoperative serum albumin levels and nutritional
status correlated with higher risk for postoperative infectious complications.
Conclusions. Malnourished patients undergoing cytoreductive surgery and hyperthermic
intraperitoneal chemotherapy are more prone to post-operative infectious complications and
adequate perioperative nutritional support should be considered, including immune-enhancing
nutrition. Sequential monitoring of common sites of infection, antifungal prevention of candidiasis,
and careful patient selection should be implemented to reduce complications rate.