Risk Factors And Prophylaxis Of Complications Incured By Postoperative Hyperthermic Intraperitoneal Chemotherapy For Colorectal Cancer: A Retrospective Study

Objective To analyze the risk factors and prophlaxis of complications incurred by postoperative Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for colorectal cancer. Methods 234 patients underwent HIPEC after radical resection from January 1997 to March 2007 were studied retrospectively, including rectal cancer(n=112), colon cancer(n=122); stageâ…¡B(n=108), stageIII(n=126). All cases were then divided into 2 groups: complication group(n=87) and non-complication group(n=147). After analyzing 12 possible factors such as age, genger, location of cancinoma, differentiation degree, pathologic type, TNM staging, abdominal surgery history, operation method,, prophylactic stoma, postoperative complication, course of treatment and medication for HIPEC complication by single factor and Logistic regression analysis, the risk factors were then determined by OR value.Results Incidence of overall complication after HIPEC was 37.18%, catheter-associated complications was 20.51%, gastrointestinal adverse event was 22.22%, myelosuppression was 12.82%, liver and renal function damage was 7.69%, chemical peritonitis was 18.99%, adhesive ileus was 12.39%, adhesive ileus after chemical peritonitis was 57.80%, the rate in adhesive ileus was 89.60%. the incidence of adhesive ileus in multiple courses of treatment group was 23.81% while in single couse of treatment group was 6.00%. Univariate analysis revealed that abdominal surgery history, operation method, medication, courses of treatment and postoperative complication were identified as significant risk factors for complication of HIPEC. These abdominal surgery history, laparoscopic operation, postoperative complication, multiple course of treatment and cisplatin were independent risk factors by means of multivariate logistic regression analysis, with the coefficent of regression being 3.265, -0.767, 1.603, 2.012 and 0.773 respectively, and odd ratio 26.191, 0.464, 4.966, 7.480 and 2.167 respectively.Conclusions Once or twice course of HIPEC after radical resection of colorectal cancer is safe with acceptable complications. Abdominal surgery history, laparoscopic operation, Cisplatin, multiple course of treatment and postoperative complication are related to complications of HIPEC for colorectal cancer. Laparoscopic surgery is a protective factor while the other four are risk factors. Abdominal surgery history plays the most important role among them. Chemical peritonitis causes the most of adhesive ileus in HIPEC, so Maintaining stool open during the HIPEC by varied therapic methods is supposed to be a main way to prevent adhesive ileus.