Severe pulmonary complications after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy are common and contribute to decreased overall survival

Background and objectives Extensive abdominal surgery is associated with the risk of postoperative pulmonary complications. This study aims to explore the incidence and risk factors for developing postoperative pulmonary complications after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy and to analyze how these complications affect overall survival. Methods Data were collected on 417 patients undergoing surgery between 2007 and2017 at Uppsala University Hospital, Sweden. Postoperative pulmonary complications were graded according to the Clavien-Dindo classification system where Grade ≥ 3 was considered a severe complication. A logistic regression analysis was used to analyze risk factors for postoperative pulmonary complications and a Cox proportional hazards model to assess impact on survival. Results Seventy-two patients (17%) developed severe postoperative pulmonary complications. Risk factors were full thickness diaphragmatic injury and/or diaphragmatic resection [OR 5.393, 95% CI 2.924–9.948, p = < 0.001]. Severe postoperative pulmonary complications, in combination with non-pulmonary complications, contributed to decreased overall survival [HR 2.285, 95% CI 1.232–4.241, p = 0.009]. Conclusions Severe postoperative pulmonary complications were common and contributed to decreased overall survival. Full thickness diaphragmatic injury and/or diaphragmatic resection were the main risk factors. This finding emphasizes the need for further research on the mechanisms behind pulmonary complications and their association with mortality.

Repair of Acute Diaphragmatic Injury Diagnosed within Few Days of Trauma via Thoracic Approach

BackgroundDiagnosis of diaphragmatic injury (DI) in acute trauma sittings is challenging and missed or delayed detection is not uncommon. The surgical approach for repair of acute diaphragmatic injury is mainly determined by the presence of associated injuries. In the majority of cases repair is accomplished through exploratory laparotomy together with dealing with associated intra-abdominal injuries.Cases presentationWe reported 5 cases (4 males and 1 female), age ranging from 21 to 52 years, with acute blunt diaphragmatic injury. There was a latent period of few days (ranging from 3 to 8 days) before definite diagnosis and surgical intervention. All patients were managed through small lower posterolateral thoracotomy approach without complication.ConclusionRepair of diaphragmatic injury via thoracic approach is easy, safe, and efficient. We recommend thoracic approach especially on the right side even in acute situation in absence of other indications for laparotomy.

Minimally invasive repair of right-sided blunt traumatic diaphragmatic injury

Right-sided blunt traumatic diaphragmatic injury (TDI) is a rare injury that is rarely repaired by the minimally invasive approach in the acute setting. Laparoscopic repair of right-sided TDI is challenging because the liver often obstructs access to the injury site. Herein, we report a case wherein acute right-sided blunt TDI was successfully repaired using a combined laparoscopic and thoracoscopic approach. A 30-year-old man presented with shortness of breath after falling on his back while jumping on a snowboard. CT revealed a right-sided TDI. As the patient was haemodynamically stable, laparoscopic repair was planned. Laparoscopy revealed a right-sided diaphragmatic rupture. As the posterior portion was covered by the liver and difficult to access, we added trocars in the chest cavity and closed the diaphragmatic defect with a thoracic approach. A combined laparoscopic and thoracoscopic approach can repair right-sided diaphragmatic injury by a minimally invasive approach even in the acute setting.