Related Experiment Video
Updated: May 17, 2025
Surgical Closure of Equine Abdomen, Prevention, and Management of Incisional Complications
Published on: May 10, 2024
Risk factors for postoperative evisceration after cytoreductive surgery and HIPEC. A comparative study of open and
Fatah Tidadini1, Jade Fawaz2, Jean-Louis Quesada3
1Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France; Lyon Center for Lnnovation in Cancer, EA 3738, Lyon 1 University, Lyon, France.
Background:
Standard treatment for resectable peritoneal metastasis (PM) includes the combination of cytoreductive surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Postoperative evisceration is a rare but major complication after CRS and HIPEC. This study aimed to identify the risk factors associated with evisceration after HIPEC, comparing outcomes between open and closed abdominal HIPEC.
Methods:
We conducted a retrospective multi-center study analyzing data of 233 patients with PM who underwent CRS/HIPEC between 2014 and 2023. Patients were categorized based on the HIPEC technique: Open (OPEN_HIPEC), n = 110; Closed abdominal technique (CLOSED_HIPEC), n = 123). We aimed to identify patient factors associated with evisceration within 30 days of CRS/HIPEC, using multivariate analysis.
Results:
Among 233 patients included, 129 (55.4 %) were women. The median age was 60 [51; 67] years. The OPEN_HIPEC group was significantly younger than the CLOSED_HIPEC group (median 57 [47; 62] vs 63 [54; 70] years; p ≤ 0.001) with a higher PCI score (median 9.5 [5; 17] vs 6 [2; 11]; p ≤ 0.001). Severe complications were similar between OPEN and CLOSED_HIPEC: 17 (15.5 %) vs 15 (12.2 %); p = 0.471 with no mortality. Eight (3.4 %) patients had postoperative evisceration with significantly more occurrences in the OPEN_HIPEC than in the CLOSED_HIPEC group (7/110 (6.4 %) vs 1/123 (0.8 %); p = 0.028). Univariate analysis identified chronic obstructive pulmonary disease (COPD)/respiratory pathology (HR = 7.02 [1.76-28.1]) and PCI score category of 11-15 (HR = 5.09 [1.03-25.2] as risk factors. Multivariate analysis identified a history of COPD/respiratory pathology (HR = 7.39 [1.85-29.6], p = 0.005) and OPEN_HIPEC (HR = 8.37 [1.03-68.1], p = 0.047) as risk factors of postoperative evisceration. Although suture material was not identified as a significant factor by the analysis, all eviscerations in the OPEN_HIPEC group were observed following musculoaponeurotic closures using Vicryl 1 sutures.
Conclusions:
Following CRS/HIPEC treatment, 3.4 % patients had evisceration by day 30. A history of COPD/respiratory pathology and OPEN_HIPEC technique were identified as independent risk factors associated with evisceration, necessitating reintervention. It should also be noted that in the OPEN_HIPEC group there were no eviscerations after the change to PDS sutures.
