Hepatic necrosis and hemorrhage following hyperthermic intraperitoneal chemotherapy with oxaliplatin: A review of two cases.
Bibliographic record
Abstract
Cytoreductive surgery (CS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is now becoming a standard of care for peritoneal carcinomatosis (PC) in selected patients. Eradication of macroscopic disease (nodules > 2.5 mm) is realized through meticulous CS. Following CS, intraperitoneal chemotherapy is administered to treat microscopic disease (1). An increasing number of patients presenting with PC arising from colorectal cancer (2),(3), pseudomyxoma peritonei (4), and malignant peritoneal mesothelioma (5) have been treated using this combined modality with promising results. However, this procedure is associated with significant morbidity. Major complication rates reach 52% in some series (6). Sepsis, abscesses, anastomotic leaks, thromboembolic events, haematological toxicity and renal insufficiency are the main complications described in literature (6). We herein report two unusual cases of hemorrhagic shock with hemoperitoneum associated with severe hepatic necrosis following CS and HIPEC with oxaliplatin (HIPEC-OX). Over 75 HIPEC-OX have been performed in the past five years in our center. HIPEC is performed with the abdomen open using the Coliseum technique, with skin edges retracted above the surface of the abdomen on a metallic ring. Chemotherapy solution (oxaliplatin 460mg/m(2) diluted in a 2L/m(2) volume of D5%W) is delivered in a continuous closed circuit using four 36-French drains (two inlets and two outlets) connected to two pumps. The flow rate is 1L/min for each pump, and four thermal probes inside the peritoneal cavity give continuous temperature feedback. Intra-abdominal temperature is maintained between 42°C and 44°C and the perfusion duration is 30 minutes. The infusion is then completely evacuated and the abdomen is closed. In our institution, intraperitoneal chemotherapy is not associated with simultaneous intravenous chemotherapy (5-fluorouracile), except for patients with colorectal PC. Various chemotherapeutic agents have been proposed for HIPEC (7). Oxaliplatin, a third generation platinum complex derived from cisplatinum, is a commonly used agent and one of the preferred agent for PC arising from colorectal carcinoma. It has proven activity against colorectal cancer cells and has high intra-tumoral penetration and intra-peritoneal concentration. Moreover, oxaliplatin's cytotoxicity is potentiated by hyperthermia and has a low systemic absorption, with possibly less systemic toxicity (8),(9).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.005 | 0.004 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.005 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".