RESUMO
BACKGROUND: Oxaliplatin-based hyperthermic intraperitoneal chemotherapy (HIPEC-ox) induces specific morbidity with hemorrhagic complications (HC). The aim of this study was to identify preoperative, intraoperative and postoperative HC predictive factors after HIPEC-ox. METHODS: A prospective single center study that included all consecutive patients treated with curative-intent HIPEC-ox, whatever the origin of peritoneal disease, was conducted. All patients underwent systematic blood tests exploring primary hemostasis and endothelial activation before surgical incision (D0) and on postoperative days 2 (POD2) and 5 (POD5). RESULTS: Between May 2012 and August 2015, 47 patients were enrolled in the study. The overall HC rate was 38%. Major morbidity was significantly higher in patients with HC. Patients presenting HC were significantly more often affected with pseudomyxoma peritonei and had less preoperative chemotherapy. Multivariate analysis showed that a higher plasmatic level of Von Willebrand factor antigen at D0 (D0 VWF:Ag) was a protective predictive factor for HC (p = 0.049, HR: 0.97 CI 95% [0.94-1.00]). A D0 VWF:Ag level below 138% had a sensitivity of 87.5%, a specificity of 67% and an area under the curve of 80.3% (CI 95% [66.5-94], p < 0.01) for predicting HC. CONCLUSIONS: Through the identification of prognostic factors, this study highlighted a subgroup of patients with low risk of HC after HIPEC-ox. Based on these results, we propose a routine preoperative dosage of VWF that would help the surgeon to select the most suitable patients for HIPEC-ox.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Procedimentos Cirúrgicos de Citorredução , Hipertermia Induzida/métodos , Compostos Organoplatínicos/administração & dosagem , Neoplasias Peritoneais/terapia , Hemorragia Pós-Operatória/epidemiologia , Fator de von Willebrand/metabolismo , Adulto , Idoso , Neoplasias Colorretais/patologia , Neoplasias Colorretais/terapia , Epistaxe/epidemiologia , Epistaxe/metabolismo , Epistaxe/prevenção & controle , Feminino , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/metabolismo , Hemorragia Gastrointestinal/prevenção & controle , Humanos , Infusões Parenterais , Neoplasias Intestinais/patologia , Neoplasias Intestinais/terapia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Oxaliplatina , Doenças Peritoneais/epidemiologia , Doenças Peritoneais/metabolismo , Doenças Peritoneais/prevenção & controle , Neoplasias Peritoneais/secundário , Hemorragia Pós-Operatória/metabolismo , Hemorragia Pós-Operatória/prevenção & controle , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Neoplasias Uterinas/patologia , Neoplasias Uterinas/terapia , Fator de von Willebrand/uso terapêuticoRESUMO
The injection of methotrexate is an alternative to laparoscopic surgical treatment of unruptured ectopic pregnancy. An experimental trial on rabbits was designed to evaluate this new approach. In situ injection of methotrexate does not cause either real tubal epithelial impairment, nor an adverse effect on treated rabbits' fertility. However, sub-peritoneal injections of methotrexate are responsible for a typical histological lesion. These results are discussed emphasising the importance of the way the administration is carried out.