Prognostic factors of hemorrhagic complications after oxaliplatin-based hyperthermic intraperitoneal chemotherapy: Toward routine preoperative dosage of Von Willebrand factor?
Eur J Surg Oncol
; 43(6): 1095-1101, 2017 Jun.
Article
en En
| MEDLINE
| ID: mdl-28209329
ABSTRACT
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 VWFAg) was a protective predictive factor for HC (p = 0.049, HR 0.97 CI 95% [0.94-1.00]). A D0 VWFAg 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.Palabras clave
Texto completo:
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Bases de datos:
MEDLINE
Asunto principal:
Compuestos Organoplatinos
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Neoplasias Peritoneales
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Factor de von Willebrand
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Protocolos de Quimioterapia Combinada Antineoplásica
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Hemorragia Posoperatoria
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Procedimientos Quirúrgicos de Citorreducción
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Hipertermia Inducida
Tipo de estudio:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Idioma:
En
Revista:
Eur J Surg Oncol
Año:
2017
Tipo del documento:
Article