Thoracic complications in patients undergoing intraperitoneal heated chemotherapy with mitomycin following cytoreductive surgery

Our plain-English summary of Thoracic complications in patients undergoing intraperitoneal heated chemotherapy with mitomycin following cytoreductive surgery, by M.Y. Chen, C. Chiles, B.W. Loggie, et al (Journal of Surgical Oncology, 1997).

The study

• Authors: M.Y. Chen, C. Chiles, B.W. Loggie, R.H. Choplin, M.A. Perini, R.A. Fleming
• Journal: Journal of Surgical Oncology
• Published: 1997;66(1):19-23
• Cited by: 21 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: The purpose of this study was to determine the incidence and severity of thoracic reactions in patients undergoing intraperitoneal heated chemotherapy (IPHC).

Methods: Forty-two patients who had intraperitoneal disseminated malignancies were treated with cytoreductive surgery (CS) and IPHC. The primary malignancies included carcinoma of the colon (n = 17), stomach (n = 6), appendix (n = 6), pseudomyxoma peritonei (n = 3), mesothelium (n = 2), ovaries (n = 2), jejunum (n = 2), gallbladder (n = 1), urachus (n = 1), and peritoneal carcinomatosis (n = 2). After CS, IPHC with mitomycin (MMC) was administered by perfusion at 40.5 degrees C. After IPHC, multiple radiographs of the chest were reviewed in comparison to the control group.

Results: Thoracic complications occurred in 36 patients (86%), including atelectasis in 32 patients (76%), pleural effusions in 27 (64%), pulmonary edema in 10 (24%), pneumonia in 2 (5%), and pneumothorax in 2 (5%). The incidence of thoracic complications in the IPHC group was significantly higher than that of patients in the control group (P < .05). Correlations between the prevalence of pleural effusion and the dose of MMC, duration of procedure, and presence of thrombocytopenia were not significant (P > .05).

Conclusions: Bibasilar atelectasis and pleural effusions are common findings after IPHC with MMC, but most of them do not necessarily warrant intervention.

In plain English

This retrospective study did not examine asbestos exposure. It reviewed chest X-rays of 42 patients whose cancer had spread through the abdomen. Forty were treated with surgery to remove tumor plus heated chemotherapy with the drug mitomycin circulated through the abdomen (IPHC), and two had IPHC without that surgery. Two of the 42 had cancers listed as arising from the mesothelium of the peritoneum. A comparison group of 14 patients had long abdominal cancer operations without heated chemotherapy. Chest complications appeared on X-ray in 36 of the 42 IPHC patients (86%). These were mainly atelectasis (partly collapsed lung) in 32 (76%) and fluid around the lungs (pleural effusions) in 27 (64%), most of them small. In the comparison group, 8 of 14 (57%) had chest findings and 3 (21%) had pleural effusions. Pleural effusions were significantly more frequent after IPHC. Their frequency was not significantly linked to mitomycin dose, procedure length, or low platelet counts. The authors concluded that these findings were possibly related to mitomycin toxicity, surgery, anesthesia or raised abdominal pressure, and that most cleared without intervention.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review of consecutive patients' chest radiographs, compared with a control group of patients who had prolonged surgery without heated chemotherapy
• Who was studied: 42 patients (17 women, 25 men; mean age 51, range 18 to 77) with bulky cancer spread within the abdomen, treated over a 3-year period at Bowman Gray School of Medicine, Wake Forest University. Primary sites included colon (17), stomach (6), appendix (6), and the peritoneum (pseudomyxoma peritonei in three, mesothelium in two). The control group was 14 patients (11 women, 3 men) with prolonged surgery for abdominal cancers, mostly rectal.
• Exposure: Not asbestos. The exposure was intraperitoneal heated chemotherapy, after cytoreductive surgery in most patients; two patients had IPHC without cytoreductive surgery. Mitomycin 30 mg was given as a bolus in all procedures, with an additional 10 mg after 1 hour in 35 procedures. It was given in perfusion fluid warmed to 40.5°C for 2 hours.
• Main results:
  • In the IPHC group, thoracic complications occurred in 36 of 42 patients (86%)
  • In the IPHC group, atelectasis was seen in 32 patients (76%) and pleural effusions in 27 (64%). Pulmonary edema was seen in 10 (24%), pneumonia in 2 (5%) and pneumothorax in 2 (5%).
  • In the IPHC group, pleural effusions were small in 22 patients and moderate in five
  • In the control group of 14, thoracic reactions were seen in eight patients (57%). Atelectasis was seen in seven (50%), pleural effusions in three (21%), pulmonary edema in four (29%) and pneumonia in three (21%).
  • Pleural effusions were significantly more frequent in the IPHC group than in the control group (P less than .01, two-tailed test)
  • In the IPHC group, the frequency of pleural effusion was not significantly correlated with mitomycin dose (30 mg or 40 mg), procedure duration, or thrombocytopenia (P greater than .05)
• The authors' conclusion: The authors concluded that bibasilar atelectasis and pleural effusion were higher after cytoreductive surgery with IPHC than in controls. They judged these findings possibly related to mitomycin cytotoxicity, the surgery, anesthesia, or increased intra-abdominal pressure. In most patients the complications cleared without intervention such as positive-pressure ventilation or thoracentesis.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Chemotherapy, Cytoreductive Surgery, Carcinoma, Mesothelium, Atelectasis, Pleural Effusion, Pneumothorax.

Related studies

• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis: the Danish experience — L.H. Iversen, P.C. Rasmussen, et al. (2013)
• Cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for malignant peritoneal mesothelioma: mitomycin versus cisplatin — A.U. Blackham, P. Shen, et al. (2010)
• Utility of Chemoresponse Assay in Patients Undergoing Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy — S. Bhagwandin, S. Naffouje, et al. (2015)
• A Novel Tool for Predicting Major Complications After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy — J.M. Baumgartner, T.G. Kwong, et al. (2016)
• Repeat cytoreductive surgery and heated intraperitoneal chemotherapy may offer survival benefit for intraperitoneal mesothelioma: a single institution experience — J. Wong, A.L. Koch, et al. (2014)
• Impact of Major Complications on Patients' Quality of Life After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy — T.D. Hamilton, E.L. Taylor, et al. (2016)

Browse more research in Journal of Surgical Oncology, or return to medical research.