Delayed Presentation of Major Complications in Patients UndergoingCytoreductive Surgery Plus Hyperthermic Intraperitoneal ChemotherapyFollowing Hospital Discharge

ntroduction: Peritoneal surface malignancy is increasingly treated with cytoreductive surgery (CRS) plus hyperthermic intraperitonealchemotherapy (HIPEC). This is associated with potentially high morbidity. We analyzed the incidence of delayed major complications followingCRS plus HIPEC.Methods: Delayed events were chosen as those which occurred after discharge from the hospital following CRS plus HIPEC and prior to 90 days.Major complications included any adverse event requiring intervention or intensive care unit admission.Results: One hundred thirty six patients underwent 140 procedures. Eight patients (5.7%) developed delayed major complications. Complicationswere pancreatic pseudocyst/pancreatitis (n ¼ 3), abdominal wall dehiscence (n ¼ 2), gastric perforation (n ¼ 1), and ureteral stricture withassociated hydronephrosis (n ¼ 2).All of the patients had undergone multivisceral resections. Seven patients achieved complete cytoreduction (cc  1). Mean peritonealcarcinomatosis index (PCI) was 15.25  5.33 (6–22). Standard of care was met for the management of all the complications and all patientsrecovered following intervention without any further morbidity or mortality.Conclusion: There is a lack of report of the delayed major complications in patients undergoing CRS plus HIPEC in the literature. Awarenessshould be raised among health care providers regarding possible occurrence of such late complications given that many patients undergo CRS plusHIPEC remotely from their localities.