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Intraperitoneal photodynamic therapy causes a capillary-leak syndrome
Robert J Canter1, Rosemarie Mick, Susan B Kesmodel
1Department of Surgery, University of Pennsylvania, Philadelphia, USA.
Annals of Surgical Oncology
|June 10, 2003
Summary
Intraperitoneal photodynamic therapy (IP PDT) combined with surgery causes capillary leak syndrome, requiring intensive care unit (ICU) support and prolonged ventilation for patients with disseminated cancer.
Area of Science:
- Oncology
- Surgical Oncology
- Critical Care Medicine
Background:
- Intraperitoneal (IP) photodynamic therapy (PDT) combined with aggressive surgical debulking can induce systemic capillary-leak syndrome.
- This condition necessitates intensive care unit (ICU) management post-surgery.
Purpose of the Study:
- To retrospectively review perioperative data of patients undergoing IP PDT and surgical debulking.
- To identify factors associated with prolonged mechanical ventilation and postoperative complications.
Main Methods:
- A retrospective review of 65 patients undergoing surgical debulking and IP PDT from May 1997 to May 2001.
- Statistical analyses were performed to correlate perioperative factors with outcomes.
Main Results:
- Sixty-five patients (43 women, 22 men) were treated; mean age was 49 years.
- Average operative time was 9.8 hours with 1450 mL estimated blood loss.
- 24 patients required mechanical ventilation >24 hours (mean 8.3 days); median ICU stay was 4 days.
- 45 patients (69%) experienced 110 complications, including ARDS, infections, and anastomotic issues.
Conclusions:
- Surgical debulking and IP PDT induce significant capillary-leak syndrome.
- Massive fluid resuscitation, intensive monitoring, and frequent ventilatory support are critical.
- Surgery-related factors significantly impact complication rates.