ABSTRACT
Background. Cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC) has shown better oncological outcomes in peritoneal surface malignancies (PSM). We assessed the feasibility and perioperative outcomes of this procedure in Indian patients. Methods. In this prospective observational study from February 2013 to April 2015, we included 56 patients (41 females, 73.2%) with PSM. They had a good performance status, were either treatment-naïve or previously treated by surgery and systemic chemotherapy. They underwent cytoreductive surgery followed by HIPEC using a hyperthermia pump, with the temperature at 42 °C for 30–90 minutes. The chemotherapy regimen was based on the primary malignancy. Perioperative outcome data were collected and analysed. We also analysed the short-term oncological outcomes. Results. Our patients included those with peritoneum confined ovarian carcinoma (32, 57.1%), colorectal carcinoma (9, 16.1%), pseudomyxoma peritonei (7, 12.5%), mesothelioma (2, 3.6%), gastric carcinoma (2, 3.6%) and others (4, 7.1%). The median duration of surgery including HIPEC was 9 hours and the median hospital stay was 12 days. The median time for gastrointestinal recovery was 5 days. One-fifth of patients (11, 19.7%) required an extended stay in the intensive care unit. The most common grades 3 and 4 complications were hypocalcaemia 32.1%, hypokalaemia 32.1%, anaemia 21.4% and thrombocytopenia 7.1%. Major morbidity requiring surgical intervention occurred in 8.9% of patients. The 60-day operative mortality was 1.8%. At a median follow-up of 16 months, 7.1% developed peritoneal recurrence, 8.9% had systemic recurrence and 7.1% succumbed to the disease. Patients with platinum-resistant ovarian carcinomas had more peritoneal recurrence (3.6%). Conclusion. In patients with PSM, surgical cytoreduction and HIPEC is feasible and potentially beneficial. It can be done with low mortality and acceptable morbidity. It requires a
ABSTRACT
Background: After gastrointestinal surgery like anastomosis, patients are usually not allowed to take feed orally for five days. This is to prevent post operative nausea and vomiting and also to protect the anastomotic site allowing it to heal. Aim: This randomized control study sought to compare the outcome of early Enteral feeding versus delayed feeding after gastrointestinal surgery. Materials and methods: 60 patients were randomly selected and classified into two groups, early feeding group and late feeding group and following were noted; anastomotic leak, infection (wound, intra-abdominal abscess, pulmonary complication, sepsis), length of hospital stay. Results: The mean length of hospital stay was 9.3 vs 10.90. The difference was 1.6 days (P value: 0.129). Wound infection was 20% vs 26.7%. 6.7% had intra-abdominal abscess in the early feeding group which was statistically insignificant. There were two patients (6.7%) with sepsis in late feeding group (p= 0.150). There were no anastomotic leak and no deaths in the both the groups. Conclusion: The present study indicated that there was no significant difference between the two groups. Late feeding doesn’t confer any significant advantage. There was no advantage of dietary restriction. Hence we recommend that early post-operative feeding is safer