Risk factors for gastric perforation after cytoreductive surgery in patients with peritoneal carcinomatosis: Splenectomy and increased body mass index.

BACKGROUND: Gastric perforation after cytoreductive surgery (CRS) is an infrequent complication. There is lack of evidence regarding the risk factors for this postoperative complication. The aim of this study was to assess the prevalence of postoperative gastric perforation in patients undergoing CRS for peritoneal carcinomatosis (PC) and to evaluate risk factors predisposing to this complication. METHODS: We designed a unicentric retrospective study to identify all patients who underwent an open upfront or interval CRS after a primary diagnosis of PC of different origins between March 2007 and December 2018 at a French Comprehensive Cancer Center. The main outcome was the occurrence of postoperative gastric perforation. RESULTS: Five hundred thirty-three patients underwent a CRS for PC during the study period and 13 (2.4%) presented a postoperative gastric perforation with a mortality rate of 23% (3/13). Neoadjuvant chemotherapy was administered in 283 (53.1%) patients and 99 (18.6%) received hyperthermic intraperitoneal chemotherapy (HIPEC). In the univariate analysis, body mass index (BMI), peritoneal cancer index, splenectomy, distal pancreatectomy, and histology were significantly associated with postoperative gastric perforation. After multivariate analysis, BMI (OR [95%CI] = 1.13 [1.05-1.22], p = 0.002) and splenectomy (OR [95%CI] = 26.65 [1.39-509.67], p = 0.029) remained significantly related to the primary outcome. CONCLUSIONS: Gastric perforation after CRS is a rare event with a high rate of mortality. While splenectomy and increased BMI are risk factors associated with this complication, HIPEC does not seem to be related. Gastric perforation is probably an ischemic complication due to a multifactorial process. Preventive measures such as preservation of the gastroepiploic arcade and prophylactic suture of the greater gastric curvature require further assessment.

Endermology treatment for breast cancer related lymphedema (ELOCS): Protocol for a phase II randomized controlled trial.

OBJECTIVES: Secondary lymphedema is a serious and debilitating condition, which may cause a range of cutaneous, infectious and joint complications with major psychological and social consequences. There is no curative treatment available. Initial symptomatic treatment includes Intensive Decongestive Treatment (IDT), which involves the use of multi-layered compression bandages, along with manual lymph drainage, physical exercise and skin care. IDT leads to an average decrease in limb volume of 20-40%, when compared to the contralateral limb. A better reduction may be obtained through the use of new adjuvant techniques, of which endermology is an example. The aim of this phase II study is to validate an IDT protocol combining endermology with standard of care in breast cancer related lymphedema. STUDY DESIGN: A standardised care protocol was proposed by the University Hospital of Toulouse's Lymphology team for the treatment of upper limb lymphedema after breast cancer surgery using Cellu M6 (LPG) Endermologie over 30 min. Every patient benefitted from IDT over 5 consecutive days, within the multidisciplinary Lymphology unit. Patients were randomised into three arms as follows: Arm 1: IDT for 5 days with bandages + manual lymphatic drainage. Arm 2: IDT with bandages + manual lymphatic drainage + Cellu M6 for 5 days. Arm 3: bandages + Cellu M6 for 5 days. During the study, patients will be followed-up for a period of 6 months. Use of LPG's Cellu M6 in combination with IDT may improve upper limb volume reduction compared with standard of care. By improving breast cancer related lymphedema, we expect to minimise further fluid build-up and to improve skin care, thus reducing the number of consultations and hospital admissions caused by this condition. The results of the present research protocol are expected to promote evidence supporting the use of endermology in the field of lymphology.

Pericarditis After Breast Implant Rupture: A Case Report.

A ruptured breast implant is usually asymptomatic and accidentally discovered during an imaging test. However, implant ruptures can cause isolated silicone granulomas and cases of severe systemic disease. We report the first case of a 39-year-old female patient with augmentation breast implants and myopericarditis secondary to implant rupture. Many etiologies of myopericarditis were explored, but none were selected with the exception of the rupture of the implant in the left breast. Magnetic resonance imaging showed a prosthetic rupture with capsular intrusion and formation of a silicone granuloma with inflammation of the pericardium on contact. Clinical and radiological improvement was observed in the short term after surgical removal of the implant. A review of the literature was conducted supporting the hypothesis of an autoimmune and inflammatory syndrome induced by an adjuvant.