Postoperative Gastric Perforation After Cytoreductive Surgery: An Ischemic Complication Caused By Spleen And Omental Resection

Introduction/Background Cytoreductive surgery (CRS) is the mainstay of some peritoneal malignancies. To obtain complete cytoreduction, extensive surgery with multiple visceral resections may be required. Gastric perforation is an infrequent complication and it has been associated to hyperthermic intraperitoneal chemotherapy (HIPEC), mainly explained by a multifactorial etiology. Methodology We designed a retrospective unicentric study identifying all patients who presented a gastric perforation after CRS from March 2007 to December 2018. All relevant clinical and surgical data were collected in a computerized medical database. Results Among the 858 cytoreductive procedures performed in our center, 12 gastric perforations (1.3%) were identified. HIPEC was performed in 4 out of these 12 patients. Infragastric omentectomy associated to splenectomy was carried out in all the patients presenting a gastric perforation. Median time to diagnosis was 5 days (range, 2–15). All patients underwent an emergency surgery and perforations were constantly found at the upper part of the greater gastric curvature. In 3 cases a gastropleural fistula was found, with a long and morbid management by thoracic surgeons until closure. Three patients among the 12 with a gastric perforation died during hospitalization at Intensive Care Unit (25%). Conclusion Gastric perforation is an infrequent complication after CRS probably due to ischemia at the upper part of gastric curvature caused by the ligature of gastroepiploic and short gastric vessels. This complication may occur independently of the performance of HIPEC and it should be managed with emergency surgery given its high morbimortality. A prophylactic suture of the upper part of the greater curvature in patients undergoing CRS with infragastric omentectomy and splenectomy might prevent this type of complication. Disclosure Nothing to disclose.