Gastric perforation following cytoreductive surgery with perioperative intraperitoneal chemotherapy

Gastrointestinal tract perforation after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has an incidence of 6%. The most common site is the small bowel. The trauma of CRS and delay in wound healing due to HIPEC has been thought to cause this complication.

From our database of 1,251 patients we recorded the treatments that resulted in a stomach perforation, the clinical manifestations, and the final outcome. We formulated a pathophysiology for the development of this postoperative complication.

Four patients had postoperative gastrointestinal perforation limited to the wall of the stomach (incidence 0.3%). All patients underwent greater omentectomy with ligation of the gastroepiploic vessels on the surface of the greater curvature, received HIPEC and early perioperative intraperitoneal chemotherapy. All perforations occurred along the greater curvature of the stomach. Successful management of the perforation was by suture plication of the gastric defect.

Perforation of the stomach following CRS and HIPEC likely results from vascular compromise, delay in wound healing from chemotherapy, seromuscular tears related to traction on the stomach wall and point pressure on the greater curvature from a long-term indwelling nasogastric tube. Reperitonealization of the greater curvature, if seromuscular tears occur, may help prevent this complication.