Urgent re-laparotomies in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

BACKGROUND: The objective of the study was to evaluate the morbidity-mortality results in terms of immunscore factors and to predict the outcomes of urgent re-laparotomized patients treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). METHODS: Prospectively maintained database of 661 patients treated with potentially curative intent of CRS and HIPEC through the years of 2007 and 2020 was evaluated. URL was done for 28 (4.2%) patients as unplanned re-explorative surgery; 22 (78.6%) of them was female. The median age was 57 year (ranging, 24-76 years). There were 22 (78.6%) elderly patients over 65 years old. All standard clini-co-pathological characteristics, re-operative findings, and the morbidity-mortality results were analyzed. The well-known immunoscores such as neutrophil-lymphocyte ratio (NLR), neutrophil-thrombocyte ratio (NTR), and CRP-albumin ratio (CAR) were determined. RESULTS: The main indication for URL was small bowel anastomotic leak (n=13, 46.4%). The abdominal wall disruption (n=5, 17.9%) was the second indication. The frequent localization of injured organ was again small bowel. The 28.6% of patients (n=8) were re-op-erated in early postoperative period (in 7 days), while as the rest of them (n=20, 71.4%) in 90 days. There was only one repeat-URL patient in this series. Many of the URL patients (n=16, 57.1%) had more than one co-morbidities. Delving into the overall group, there were Clavien-Dindo (C-D) Grade I-II complications in 104 (16.4%) patients and C-D Grade III-IV in 88 (13.9%) patients, whereas in URL patient group, C-D Grade III-IV complications were seen in 22 (78.6%). In this prospective cohort, the overall mortality rate was 3.2% (n=20) in patients who were not re-explored. Six (21.4%) patients were lost in URL patients, which the main reason for fail-ure-to-rescue was sepsis due to entero-enteral anastomotic leak. In four of them, multiple co-morbidities were affected the post-URL period of complex cancer care. Pre-URL median NLR, NTR, and CAR values were 9.12 (ranging, 1.72-37.5), 0.03 (ranging, 0.01-0.12), and 41.4 (ranging, 4.2-181.3), respectively. NLR and CAR values (4.71 and 28.8) estimated before pre-CRS were also significantly high (p=0.01 and p<0.01) in patients who were going to be operated for URL. These immunoscores values did not show any association in between pre-CRS and pre-URL mortal patients. CONCLUSION: The crucial decision-making factors at work were complex and complicated in 'unplanned' URL. The overall mor-bidity-mortality results seemingly depends on the severity and extent of peritoneal metastatic disease. Medically-unfit URL patients with high-risk factors should be selected to a vigilant monitoring and clinical care. Timely surgical intervention and intense management strategy are utmost important issues to lower morbi-mortality results in patients treated with URL.

Intraoperative Temperature Monitoring with Zero Heat Flux Technology (3M SpotOn Sensor) in Comparison with Tympanic and Oesophageal Temperature and Hypotermia Risk Factors: An Observational Study.

OBJECTIVE: Inadvertent hypothermia (body temperature below 35°C) is a common and avoidable challenge during surgery under anaesthesia. It is related to coagulation (clotting) disorders, an increase in blood loss, and a higher rate of wound infection. One of the methods for non-invasive monitoring of the core body temperature is the 3M SpotOn zero heat flux method. In this approach, sensors placed at the frontal region of the patient measure the skin temperature by creating an isothermic channel. The study aimed to determine the risk factors for hypothermia and compare the 3M SpotOn zero heat flux method with the tympanic membrane (eardrum) and oesophageal (food pipe) temperature measurement methods. DESIGN: Observational. DATA SOURCES: The patients' data were collected, including age, gender, weight, BMI, other illnesses, smoking history, type of anaesthesia, duration of surgery, operating room temperature, pulse rate, blood pressure, blood loss, and transfusions. Body temperature was measured by the tympanic membrane method before and after surgery, oesophageal method during surgery, and SpotOn measurements throughout all three periods were recorded. ELIGIBILITY CRITERIA: Inclusion criteria was: adult patients, both genders, who had undergone major abdominal cancer surgery at the trialists' institution, in whom the SpotOn zero heat flux, tympanic membrane, and oesophageal temperature measurement methods had all been used. Participant exclusion criteria was the absence of recorded data. RESULTS: In this study, inadvertent intraoperative hypothermia incidence was 38.1% in the recovery room. Although gender, presence of comorbidities, history of smoking, administration of epidural anaesthesia, and requirement of blood transfusion [red blood cells (RBCs) and fresh frozen plasma (FFP)] did not affect hypothermia significantly during admission to the recovery room, prewarming the patient throughout the operation prevented the occurrence of hypothermia significantly (p=0.004). Additionally, as the American Society of Anaesthesiologists (ASA) physical status score worsened, the rate of hypothermia increased significantly (Frequency: 1st degree, 29.4%; 2nd degree, 47.5%; 3rd degree, 66.7%; X2 Slope- p=0.047). CONCLUSION: The most significant risk factor was found to be not prewarming the patient as a strict procedure, and as the ASA physical status score worsened, the rate of hypothermia increased significantly. Besides, the SpotOn method provided temperature measurements as good as the oesophageal temperature measurements. Clinical Trial registration: ISRCTN 14027708.