Procalcitonin levels predict infectious complications and response to treatment in patients undergoing cytoreductive surgery for peritoneal malignancy

2016 ◽  
Vol 42 (2) ◽  
pp. 234-243 ◽  
Author(s):  
K. Saeed ◽  
A.P. Dale ◽  
E. Leung ◽  
T. Cusack ◽  
F. Mohamed ◽  
...  
Keyword(s):  
Cytoreductive Surgery ◽  
Infectious Complications ◽  
Response To Treatment ◽  
Peritoneal Malignancy

scholarly journals Postoperative paralytic ileus after cytoreductive surgery combined with heated intraperitoneal chemotherapy

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Jesper Nors ◽  
Jonas Amstrup Funder ◽  
David Richard Swain ◽  
Victor Jilbert Verwaal ◽  
Tom Cecil ◽  
...  
Keyword(s):  
Median Time ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Paralytic Ileus ◽  
University Hospital ◽  
Nasojejunal Tube ◽  
Heated Intraperitoneal Chemotherapy ◽  
Duration Of Surgery ◽  
Crs And Hipec ◽  
Peritoneal Malignancy

AbstractBackgroundPatients with peritoneal malignancy treated by cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) are prone to develop postoperative paralytic ileus (POI). POI is associated with significant increase in both morbidity and mortality. CRS and HIPEC commonly result in prolonged POI (PPOI). The objective was to clarify the extent of PPOI in patients treated by CRS and HIPEC for peritoneal malignancy.MethodsThis was a prospective multicenter study including patients operated with CRS and HIPEC at the Department of Surgery, Aarhus University Hospital, Denmark and the Peritoneal Malignancy Institute, Basingstoke, United Kingdom. A total of 85 patients were included over 5 months. Patients prospectively reported parameters of postoperative gastrointestinal function in a diary from post-operative day 1 (POD1) until discharge. PPOI was defined as first defecation on POD6 or later.ResultsMedian time to first flatus passage was 4 days (range 1–12). Median time to first defecation was 6 days (1–14). Median time to removal of nasojejunal tube was 4 days (3–13) and 7 days (1–43) for nasogastric tube. Forty-six patients (54%) developed PPOI. Patients with PPOI had longer time to first flatus (p<0.0001) and longer time to removal of nasojejunal tube (p=0.001). Duration of surgery correlated to time to first flatus (p=0.015) and time to removal of nasogastric or nasojejunal tube (p<0.0001) but not to time to first defecation (p=0.321).ConclusionsPostoperative gastrointestinal paralysis remains a common and serious problem in patients treated with CRS and HIPEC.

Treatment of Steroid-Resistant Acute GvHD with OKT3 and High-Dose Steroids Versus High-Dose Steroids Alone.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 141-141
Author(s):  
Stefan Knop ◽  
Holger Hebart ◽  
Alois Gratwohl ◽  
Ernst Holler ◽  
Jane F. Apperley ◽  
...  
Keyword(s):  
Conditioning Regimen ◽  
Infectious Complications ◽  
Response To Treatment ◽  
High Dose ◽  
Steroid Resistant ◽  
Organ Systems ◽  
Incidence And Mortality ◽  
Significant Difference ◽  
One Year ◽  
Disease Free

Abstract Despite new conditioning regimens and introduction of novel immunosuppressants in hematopoietic cell transplantation (HCT), acute graft-versus-host disease (aGvHD) remains an often life threatening complication. Methylprednisolone (MP) 2 mg/kg body weight (BW) per day is the initial standard treatment with escalation to high-dose MP (10 mg/kg BW per day) for non-responders. Recently, we demonstrated OKT3 muromonab to be an effective second-line and subsequent salvage treatment. Response duration, however, was frequently short-lived in those extensively pretreated patients and inversely correlated with duration from allografting. In the current randomized multicenter trial we investigated high-dose MP (HD-MP) versus OKT3 5 mg per day plus HD-MP. Primary endpoints were response to treatment after 100 days and survival at one year from HCT. Secondary endpoints were side effects and incidence of infectious complications. Patients with resistant °II to IV aGvHD on standard MP following allogeneic HCT were randomized to HD-MP or OKT3 + HD-MP after exclusion of other severe HCT-related complications. Eighty patients from 6 transplant centers were enrolled. Median age for the 40 patients who received OKT3 + HD-MP was 40 (range, 19 – 65) years and for the 40 patients who received HD-MP 39 (range, 19 – 56) years. There was no statistical significant difference between the groups for severity of aGvHD (°II vs. °III/IV); stem cell source (bone marrow vs. peripheral blood progenitor cells); GvHD prophylaxis (CSA vs. ATG+CSA); and conditioning regimen (TBI/Cy vs. Bu-Cy). However, significantly fewer HCTs in the OKT3 + HD-MP group were from HLA-identical siblings. Currently, 62 subjects are evaluable for response. In both arms, reduction of severe and proportional increase of moderately-severe aGvHD was observed with resolution of all °IV cases until day +30. However, significantly more patients in the OKT3 + HD-MP became disease-free (°0) by day +100 when compared to patients treated with HD-MP alone: 39.3 % vs. 20.6 % (p=0.03). In the OKT3 + HD-MP group relative increase of disease-free patients was higher for all organ systems at all time points when compared to patients on HD-MP treatment without reaching statistical. With respect to infectious complications, the incidence of both bacterial and viral infections was slightly and for invasive aspergillosis significantly higher in the HD-MP when compared to the OKT3 + HD-MP group (20.6 vs. 10.7 %; p=0.025). Treatment related mortality was higher in the HD-MP group when compared to the OKT3 + HD-MP group by days +30 (32.3 vs. 10.7 %) and +100 (55. 9 vs. 39.3 %). However, this did not translate into a significantly better one-year survival with the currently evaluable patients: one-year survival for the HD-MP group was 32.4 % and for the OKT3 + HD-MP group 46.4 %. (p=0.72). We conclude that OKT3 + HD-MP results in higher response rates for patients with steroid-resistant aGvHD and thus leads to a better immune reconstitution after HCT what is reflected by reduced incidence and mortality of infectious complications. Final results of the trial will be presented.

Infectious Complications after Cytoreductive Surgery and Hyperthermic Intra-Peritoneal Chemotherapy

2017 ◽  
Vol 18 (2) ◽  
pp. 157-163 ◽  
Author(s):  
Naciye Cigdem Arslan ◽  
Selman Sokmen ◽  
Vildan Avkan-Oguz ◽  
Funda Obuz ◽  
Aras Emre Canda ◽  
...  
Keyword(s):  
Cytoreductive Surgery ◽  
Infectious Complications

scholarly journals Microbiological monitoring in patients with advanced ovarian cancer before and after cytoreductive surgery – a preliminary report

2017 ◽  
Vol 30 (4) ◽  
pp. 198-202 ◽  
Author(s):  
Maria Szymankiewicz ◽  
Krzysztof Koper ◽  
Konrad Dziobek ◽  
Zbigniew Kojs ◽  
Lukasz Wicherek
Keyword(s):  
Escherichia Coli ◽  
Ovarian Cancer ◽  
Cytoreductive Surgery ◽  
Large Bowel ◽  
Advanced Ovarian Cancer ◽  
Infectious Complications ◽  
E Coli ◽  
Microbiological Monitoring ◽  
Before And After ◽  
Etiological Agents

Abstract Multidrug-resistant organisms (MDROs) are becoming an increasing problem in hospitals. It is believed that screening patients for the incidence of MDROs prior to hospital admission not only allows for the proper management of infection following medical procedures, but can also potentially reduce the transmission of these bacteria to other patients. The aim of this study was to assess the carriers of selected MDROs in the gastrointestinal tract among patients with advanced ovarian cancer admitted to the hospital for cytoreductive surgery and to estimate the possible relationship between rectal colonization with these organisms and nosocomial infections. From December 2013 to May 2014, we evaluated the colonization with VRE (vancomycin-resistant Enterococcus), E. coli KPC+ (class A carbapenemase producing Escherichia coli), E. coli MBL+ (class B carbapenemase, metallo-ß lactamase producing Escherichia coli), and E. coli ESBL+ (extended-spectrum ß-lactamase producing Escherichia coli) in 42 patients. The patients were divided into two subgroups corresponding to the extent of their surgery: the first subgroup consisted of patients with large bowel resection (n=18) and the second subgroup of patients without resection (n=24). A rectal swab was taken within 24 hours of admission. Perioperative infectious complications were analyzed for the first 90 days following surgery with regard to the type of infection and the occurrence of examined MDROs. In our study, 2.4 % of all patients (23.8/1,000 hospitalizations) were colonized with ESBL - producing Escherichia coli: 0.0 % in the first subgroup and 4.2% in the second subgroup, respectively. We did not identify any patients who were colonized with VRE, E. coli MBL+, or E. coli KPC+. Surgical site infections were seen in 8 (19.1%) out of 42 patients. We were, therefore, unable to confirm a relationship between MDROs colonizing the large bowel and the etiological agents of perioperative infections. However, despite the lack of identification of MDROs as etiological agents of postoperative infection, the risk of serious infectious complications, combined with the changing epidemiological situation, means that microbiological monitoring should be performed in patients with ovarian cancer before and after cytoreductive surgery.

scholarly journals An update of peritonectomy procedures used in cytoreductive surgery for peritoneal malignancy

2019 ◽  
Vol 36 (1) ◽  
pp. 743-751
Author(s):  
Frédéric Mercier ◽  
Faheez Mohamed ◽  
Jean-Baptiste Cazauran ◽  
Vahan Kepenekian ◽  
Delphine Vaudoyer ◽  
...  
Keyword(s):  
Cytoreductive Surgery ◽  
Peritonectomy Procedures ◽  
Peritoneal Malignancy

Biomarkers in pancreatic neuroendocrine tumors.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 166-166
Author(s):  
Angela Tatiana Alistar ◽  
Richard Warner ◽  
Erin Moshier ◽  
Michelle Kim ◽  
Randall F. Holcombe
Keyword(s):  
Neuroendocrine Tumors ◽  
Cytoreductive Surgery ◽  
Response To Treatment ◽  
Serotonin Level ◽  
Pancreatic Neuroendocrine Tumors ◽  
Probability Of Survival ◽  
Post Surgery ◽  
Progression Of Disease ◽  
Early Late

166 Background: This study was designed to determine the role of Chromogranin A (CGA) and serotonin as prognostic biomarkers in relation with cytoreductive surgery for pancreatic neuroendocrine tumors (PNETs).The role of CGA and serotonin as biomarkers for PNETs is not fully established. Clinicians use CGA to monitor progression of disease and response to treatment; however this hasn’t been fully validated. There is no definitive data for serotonin as prognostic biomarker in PNETs. Methods: A retrospective study of patients with PNETs seen at Mount Sinai from 1980 to 2011 was performed. All patients (142) that have had CGA and serotonin concentrations measured at least once were evaluated. Data relating to diagnosis, therapies and survival outcome were noted Results: We evaluated the probability of survival post cytoreductive surgery among patients characterized by their postoperative CGA and serotonin values. 27 patients have had CGA level measured early post-op (0 to 3 months) and 30 patients have had CGA measurement late post-op (3-12 months). We identified no correlation between survival and a normal CGA early post-op (p = 0.5895). We identified a trend (p=0.1369) towards increase in survival for patients with a normal CGA late post-op with a probability in survival of 92.86% vs 65.12% at 3 years and median months to death of 80.265 for normal CGA vs 50.39 months for high CGA late post-op. For the 22 patients that had both a CGA early and late post-op the probability of survival by their change from early to late post- surgery CgA values was not statistically significant (p=0.2903). Serotonin did not correlate with survival in any of the 3 analyses: early post op, late postop or change in serotonin level. Conclusions: The role of CGA as a predictive or prospective biomarker for PNETs is worth prospective investigation. Our study shows that late post-op CGA may predict clinical outocome while CGA early postop and serotonin early, late and change post op did not have value in predicting survival.

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