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Publications

Journal Article Ppublish

PubMed: 42648157 DOI: 10.1016/j.suronc.2026.102524

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

Surg Oncol 68:102524

Authors: Catherine Arvieux, Frédéric Dumont, Isabelle Sourrouille, Jean-Louis Quesada, Pierre-Yves Sage, Thierry Michy, Juliette Bernard, Juliette Fischer, Jean-Jacques Tuech, Fatah Tidadini

Affiliations

  • Department of Digestive and Emergency Surgery, Grenoble-Alpes University Hospital, Grenoble, France; Lyon Center for Innovation in Cancer, Lyon 1 University, EA 3738, Lyon, France.
  • Department of Surgical Oncology, ICO René Gauducheau Cancer Center, Saint-Herblain, France.
  • Department of Surgical Oncology, Gustave Roussy Cancer Center, Villejuif, 94800, France.
  • Clinical Pharmacology Unit, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France.
  • Department of Digestive and Emergency Surgery, Grenoble-Alpes University Hospital, Grenoble, France.
  • Department of Gynecology, Grenoble University Hospital, La Tronche, 38700, France.
  • Department of Surgical Oncology, Charles Nicolle University Hospital, Rouen, France.
  • Department of Digestive and Emergency Surgery, Grenoble-Alpes University Hospital, Grenoble, France; Lyon Center for Innovation in Cancer, Lyon 1 University, EA 3738, Lyon, France.

Abstract

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.

MeSH

Neoplasm Metastasis, Wounds And Injuries