Introduction: Cytoreductive surgery (CS) in patients with recurrent Stage III ovarian carcinoma combined with immediate postoperative intraperitoneal chemotherapy (IPIPC) has demonstrated improved survival rates in systemic chemotherapy failures. However, this study revealed a 58% postoperative (p.o.) complication rate, 61% involving the GIT (proc. ASCO 19.395).
Methods: 25 patients underwent CS and IPIPC; 22 underwent CS combined with extensive small bowel, colorectal, and gastric resections. Intraperitoneal chemotherapy was initiated daily for 4 days beginning 24 hours p.o. Peritoneal fluid was cultured daily during the IPIPC.
Results: 11/18 major GIT complications occurred in 25 patients after 31 procedures 2-10 days p.o.; prolonged ileus (>14 days) and small bowel obstruction (6), small-large bowel-peritoneal fistulas (3), rectovaginal fistula (1), colovesical fistula (1). Of the 6 patients with ileus and SBO, all were treated with NG (2-3 wks) with complete resolution. 2 of 3 patients with bowel fistulas underwent immediate repair with resection (2-10 days p.o.). The operated patients¢ hospitalizations averaged 26 days as opposed to 60 days in the patient treated non-operatively. The patient with the rectovaginal fistula was treated with colostomy and the colovesical fistula was treated with immediate repair, with an average hospital stay of 21 days. Peritoneal fluid cultures were positive for enteric organisms in only 2 of 5 with bowel fistulas. Re-operation in all cases was carried out without significant adhesion formation complicating the procedures.
Conclusions: Intestinal fistulas following CS and IPIPC are best treated with immediate re-operation. This allows resumption of intraperitoneal chemotherapy, if necessary. Rarely, late fistulas can be treated with catheter drainage, however, at a cost of prolonged hospitalization. Prolonged ileus and SBO can be treated with NG decompression with resolution in most cases. Routine peritoneal fluid cultures may identify early fistulas but not late fistulas. Parenteral nutrition initiated immediately p.o. is mandatory.
