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Introduction. Cytoreductive surgery (CS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a new approach for peritoneal carcinomatosis. However, high rates of complications are associated with CS and HIPEC due to treatment complexity; that is why some patients need stabilization and surveillance for complications in the intensive care unit. Objective. This study analyzed that ICU stay is necessary after HIPEC. Methods. 39 patients with peritoneal carcinomatosis were treated according to strict selection criteria with CS and HIPEC, with closed technique, and the chemotherapy administered were cisplatin 25 mg/m(2)/L and mitomycin C 3.3 mg/m(2)/L for 90-minutes at 40.5°C. Results. 26 (67%) of the 39 patients were transferred to the ICU. Major postoperative complications were seen in 14/26 patients (53%). The mean time on surgical procedures was 7.06 hours (range 5-9 hours). The mean blood loss was 939 ml (range 100-3700 ml). The mean time stay in the ICU was 2.7 days. Conclusion. CS with HIPEC for the treatment of PC results in low mortality and high morbidity. Therefore, ICU stay directly following HIPEC should not be standardized, but should preferably be based on the extent or resections performed and individual patient characteristics and risk factors. Late complications were comparable to those reported after large abdominal surgery without HIPEC.
RESUMEN
BACKGROUND: Bone reconstruction is a common problem in the oncological setting. Mandibular reconstruction is done with microvascularized free flaps, but noticeable differences in shape and size exist in relation to the normal mandible; consequently, new reconstructive methods are desirable. We explored the feasibility of recovering osseous viability using a sterilized mandibular segment reconstituted with autologous bone marrow. METHODS: A 6- to 7-cm mandibular segment was excised in three Creole dogs. The segment was autoclaved for 40 min. The bone was then drilled, producing 3-mm holes every 10-mm. Bone was reconstituted with autologous bone marrow from the iliac spine mixed with particulated bone. Bone autograph was installed underneath the latissimus dorsi muscle. RESULTS: On week four after surgery, dogs received colloidal rhenium and were placed in a gamma camera. The study showed uptake of the radiotracer in the bone graft, demonstrating viability of bone marrow. One hour later, the autograph was excised in two dogs and a histopathological study corroborated the viability of the bone marrow and the formation of new vessels and osteoid. On week twelve, the third dog was administered MDP-99Tc and placed in a gamma camera. Results proved production of new bone. CONCLUSIONS: Osseous reconstruction with microvascularized flaps may cause problems, but sterilized bone reconstituted with bone marrow becomes viable. This observation eventually would allow osseous reconstruction, including the mandibule, easily and reliably in patients with osseous tumors. Autoclaved bone reconstituted with bone marrow recovers its viability.