Improving surgical management of patients with extensive peritoneal metastases using damage control techniques.

INTRODUCTION

Damage control surgery (DCS) is a well-established standard of management for severe abdominal trauma which has been developed as a rescue technique to prevent Abdominal Compartment Syndrome. DCS is also widely used for non-trauma patients and in some cases for patients undergoing cytoreductive surgery. We aim to evaluate the benefits of DCS following CRS with or without HIPEC in a curative intent with a decision of two-stage surgery.

METHODS

Between July 2016 to January 2024, 16 patients with a decision for planned reintervention just before or during the initial surgery were included in 4 expert centers. Patients were optimally resuscitated for 6 to 72 h depending on the clinical-biological context and the initial DCS indication (Step1-SURG), and then underwent second-look surgery (Step2-SURG).

RESULTS

The median age was 57.5 [45.5; 64] years. The origin of carcinomatosis was pseudomyxoma (12), ovarian (2), appendicular (1) or rectal (1), and 9 underwent HIPEC. Median PCI score was 30.5. The median length of surgery was 550 min for the Step1-SURG and 240 min for the Step2-SURG, with a median delay of 1.5 days. Severe complication rates were respectively, 50% and 69%. 1 (6.25%) patient died after the Step2-SURG. The median OS and RFS were 51.3 and 27.7 months respectively, all etiologies combined.

CONCLUSIONS

Our results suggest a two-stage approach based on damage-control principles may be feasible in selected patients undergoing extensive CRS/HIPEC in expert centers. However, further studies with clearer selection criteria and comparative cohorts are needed.