Acute Abdominal Complications in Deeply Neutropenic Onco-Hematology Patients: A Retrospective Series of 105 Cases.
Journal
World journal of surgery
ISSN: 1432-2323
Titre abrégé: World J Surg
Pays: United States
ID NLM: 7704052
Informations de publication
Date de publication:
10 2022
10 2022
Historique:
accepted:
12
06
2022
pubmed:
12
7
2022
medline:
9
9
2022
entrez:
11
7
2022
Statut:
ppublish
Résumé
Acute abdominal complications (AAC) in patients with deep neutropenia (DN) is challenging to manage because of the expected influence of AAC on oncological prognosis and higher surgical complication rate in a period of DN. In practice, these parameters are difficult to appreciate. This study reported our experience in managing these patients. All consecutive patients treated in our tertiary care cancer center between 2010 and 2020 who developed AAC in the context of a DN were retrospectively analyzed. AAC was defined as an infection (intra-abdominal, perineal, or cutaneous), bowel obstruction, or intra-abdominal hemorrhage. Among 105 patients, 18 (17%) required emergent surgery (group 1), 34 patients had a complication requiring surgical oversight (group 2), and 53 patients had a non-surgical etiology (group 3). Fifteen patients underwent surgery in the group 1, three in group 2, and one in group 3. Overall, 28 patients died during hospitalization. Mortality was statistically different between the groups (p = 0·01), with a higher rate in group 1 (n = 9/18, 50%) than in group 2 (n = 11/34, 32%) and group 3 (n = 8/53, 15%). All groups together had a median overall survival (OS) of 14 months and disease-free survival (DFS) of 10 months. OS was not comparable between the groups, and the median length of survival in group 1 was 6 months versus 8 months in group 2 and 23 months in group 3. In group 1, five patients (5/18, 28%) did not relapse at the end of the follow-up compared to 13 in group 2 (13/34, 38%) and 25 in group 3 (25/53, 47%). After discharge, OS and DFS were similar between the groups. The advent of an AAC necessitating surgery in the context of DN is a deadly event associated with a 50% mortality; nonetheless, in case of unpostponable emergencies, surgery can provide long-term survival in selected patients.
Sections du résumé
BACKGROUND
Acute abdominal complications (AAC) in patients with deep neutropenia (DN) is challenging to manage because of the expected influence of AAC on oncological prognosis and higher surgical complication rate in a period of DN. In practice, these parameters are difficult to appreciate. This study reported our experience in managing these patients.
METHODS
All consecutive patients treated in our tertiary care cancer center between 2010 and 2020 who developed AAC in the context of a DN were retrospectively analyzed. AAC was defined as an infection (intra-abdominal, perineal, or cutaneous), bowel obstruction, or intra-abdominal hemorrhage.
FINDINGS
Among 105 patients, 18 (17%) required emergent surgery (group 1), 34 patients had a complication requiring surgical oversight (group 2), and 53 patients had a non-surgical etiology (group 3). Fifteen patients underwent surgery in the group 1, three in group 2, and one in group 3. Overall, 28 patients died during hospitalization. Mortality was statistically different between the groups (p = 0·01), with a higher rate in group 1 (n = 9/18, 50%) than in group 2 (n = 11/34, 32%) and group 3 (n = 8/53, 15%). All groups together had a median overall survival (OS) of 14 months and disease-free survival (DFS) of 10 months. OS was not comparable between the groups, and the median length of survival in group 1 was 6 months versus 8 months in group 2 and 23 months in group 3. In group 1, five patients (5/18, 28%) did not relapse at the end of the follow-up compared to 13 in group 2 (13/34, 38%) and 25 in group 3 (25/53, 47%). After discharge, OS and DFS were similar between the groups.
INTERPRETATION
The advent of an AAC necessitating surgery in the context of DN is a deadly event associated with a 50% mortality; nonetheless, in case of unpostponable emergencies, surgery can provide long-term survival in selected patients.
Identifiants
pubmed: 35816234
doi: 10.1007/s00268-022-06653-3
pii: 10.1007/s00268-022-06653-3
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2389-2398Informations de copyright
© 2022. The Author(s) under exclusive licence to Société Internationale de Chirurgie.
Références
Freifeld AG, Bow EJ, Sepkowitz KA et al (2011) Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis 52:e56-93
doi: 10.1093/cid/cir073
Hughes WT, Armstrong D, Bodey GP et al (2002) 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 34:730–751
doi: 10.1086/339215
Forrest GN, Schimpff SC, Cross A (2002) Febrile neutropenia, colony-stimulating factors and therapy: time for a new methodology? Support Care Cancer 10:177–180
doi: 10.1007/s00520-002-0347-2
Rapoport BL, Aapro M, Paesmans M et al (2018) Febrile neutropenia (FN) occurrence outside of clinical trials: occurrence and predictive factors in adult patients treated with chemotherapy and an expected moderate FN risk. Rationale and design of a real-world prospective, observational, multinational study. BMC Cancer. https://doi.org/10.1186/s12885-018-4838-z
doi: 10.1186/s12885-018-4838-z
pubmed: 30249215
pmcid: 6154917
Gorschlüter M, Mey U, Strehl J et al (2005) Neutropenic enterocolitis in adults: systematic analysis of evidence quality. Eur J Haematol 75:1–13
doi: 10.1111/j.1600-0609.2005.00442.x
Hohenberger P, Buchheidt D (2005) Surgical interventions in patients with hematologic malignancies. Crit Rev Oncol Hematol 55:83–91
doi: 10.1016/j.critrevonc.2005.03.004
Esposito S, Bassetti M, Concia E et al (2017) Diagnosis and management of skin and soft-tissue infections (SSTI). A literature review and consensus statement: an update. J Chemother. 29:197–214
doi: 10.1080/1120009X.2017.1311398
Averbuch D, Orasch C, Cordonnier C et al (2013) European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia. Haematologica 98:1826–1835
doi: 10.3324/haematol.2013.091025
Guarana M, Nucci M, Nouér SA (2009) Shock and early death in hematologic patients with febrile neutropenia. Antimicrob Agents Chemother. https://doi.org/10.1128/AAC.01250-19
doi: 10.1128/AAC.01250-19
Azoulay E, Mokart D, Pène F et al (2013) Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium–a groupe de recherche respiratoire en réanimation onco-hématologique study. J Clin Oncol 31:2810–2818
doi: 10.1200/JCO.2012.47.2365
Lebon D, Biard L, Buyse S et al (2017) Gastrointestinal emergencies in critically ill cancer patients. J Crit Care 40:69–75
doi: 10.1016/j.jcrc.2017.03.015
Solomkin JS, Mazuski JE, Bradley JS et al (2010) Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the surgical infection society and the infectious diseases society of America. Clin Infect Dis 50:133–164
doi: 10.1086/649554
Bala M, Kashuk J, Moore EE et al (2017) Acute mesenteric ischemia: guidelines of the world society of emergency surgery. World J Emerg Surg 12:38
doi: 10.1186/s13017-017-0150-5
Jung N, Eckmann C (2019) Essentials in the management of necrotizing soft-tissue infections. Infection 47:677–679
doi: 10.1007/s15010-019-01316-3
Mayumi T, Okamoto K, Takada T et al (2018) Tokyo Guidelines 2018: management bundles for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 25:96–100
doi: 10.1002/jhbp.519
Findlay JM, Kafsi JE, Hammer C, Gilmour J, Gillies RS, Maynard ND (2016) Nonoperative management of appendicitis in adults: a systematic review and meta-analysis of randomized controlled trials. J Am Coll Surg 223:814-824.e2
doi: 10.1016/j.jamcollsurg.2016.09.005
Rodrigues FG, Dasilva G, Wexner SD (2017) Neutropenic enterocolitis. World J Gastroenterol 23:42–47
doi: 10.3748/wjg.v23.i1.42
Guh AY, Kutty PK (2018) Clostridioides difficile Infection. Ann Intern Med 169:ITC49-64
doi: 10.7326/AITC201810020
Rami Reddy SR, Cappell MS (2017) A systematic review of the clinical presentation, diagnosis, and treatment of small bowel obstruction. Curr Gastroenterol Rep 19:28
doi: 10.1007/s11894-017-0566-9
Garnett C, Apperley JF, Pavlů J (2013) Treatment and management of graft-versus-host disease: improving response and survival. Ther Adv Hematol 4:366–378
doi: 10.1177/2040620713489842
Littlewood KE (2008) The immunocompromised adult patient and surgery. Best Pract Res Clin Anaesthesiol 22:585–609
doi: 10.1016/j.bpa.2008.05.005
Saillard C, Zafrani L, Darmon M et al (2018) The prognostic impact of abdominal surgery in cancer patients with neutropenic enterocolitis: a systematic review and meta-analysis, on behalf the Groupe de Recherche en Réanimation Respiratoire du patient d’Onco-Hématologie (GRRR-OH). Ann Intensive Care 8:47
doi: 10.1186/s13613-018-0394-6
Glenn J, Funkhouser WK, Schneider PS (1989) Acute illnesses necessitating urgent abdominal surgery in neutropenic cancer patients: description of 14 cases and review of the literature. Surgery 105:778–789
pubmed: 2658181
Jolissaint JS, Harary M, Saadat LV et al (2019) Timing and outcomes of abdominal surgery in neutropenic patients. J Gastrointest Surg 23:643–650
doi: 10.1007/s11605-018-04081-0
Antoun S, Elias D, Lasser P et al (2001) The medical and surgical management of acute abdominal complications in neutropenic cancer patient: description of 21 cases. Bull Cancer 88:426–34
pubmed: 11371379
Chirletti P, Barillari P, Sammartino P et al (1993) The surgical choice in neutropenic patients with hematological disorders and acute abdominal complications. Leuk Lymphoma 9:237–241
doi: 10.3109/10428199309147376
Scully RE, Mark EJ, McNeely WF, Ebeling SH, Phillips LD (1997) Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 20–1997. A 74-year-old man with progressive cough, dyspnea, and pleural thickening. N Engl J Med. 336:1895–903
doi: 10.1056/NEJM199706263362608
Weinberger M, Hollingsworth H, Feuerstein IM, Young NS, Pizzo PA (1993) Successful surgical management of neutropenic enterocolitis in two patients with severe aplastic anemia. Case reports and review of the literature. Arch Intern Med. 153:107–13
doi: 10.1001/archinte.1993.00410010127013
Badgwell BD, Cormier JN, Wray CJ et al (2008) Challenges in surgical management of abdominal pain in the neutropenic cancer patient. Ann Surg 248:104–109
doi: 10.1097/SLA.0b013e3181724fe5
Sachak T, Arnold MA, Naini BV et al (2015) Neutropenic enterocolitis: new insights into a deadly entity. Am J Surg Pathol 39:1635–1642
doi: 10.1097/PAS.0000000000000517
Mokart D, Darmon M, Resche-Rigon M et al (2015) Prognosis of neutropenic patients admitted to the intensive care unit. Intensive Care Med 41:296–303
doi: 10.1007/s00134-014-3615-y
Mokart D, Penalver M, Chow-Chine L et al (2017) Surgical treatment of acute abdominal complications in hematology patients: outcomes and prognostic factors. Leuk Lymphoma 58:2395–2402
doi: 10.1080/10428194.2017.1296145
Raynard et al. Insuffisance hépatique et manifestations digestives en oncohématologie- ClinicalKey. https://vpn.gustaveroussy.fr/,DanaInfo=www.clinicalkey.fr,SSL+#!/content/book/3-s2.0-B9782294769283003012 (accessed Nov 4, 2020).
Cohen JS, Paz IB, O’Donnell MR, Ellenhorn JD (1996) Treatment of perianal infection following bone marrow transplantation. Dis Colon Rectum 39:981–985
doi: 10.1007/BF02054685
Tengberg LT, Cihoric M, Foss NB et al (2017) Complications after emergency laparotomy beyond the immediate postoperative period - a retrospective, observational cohort study of 1139 patients. Anaesthesia 72:309–316
doi: 10.1111/anae.13721
Zuckermann J, Moreira LB, Stoll P, Moreira LM, Kuchenbecker RS, Polanczyk CA (2008) Compliance with a critical pathway for the management of febrile neutropenia and impact on clinical outcomes. Ann Hematol 87:139–145
doi: 10.1007/s00277-007-0390-7
Keng MK, Thallner EA, Elson P et al (2015) Reducing time to antibiotic administration for febrile neutropenia in the emergency department. J Oncol Pract 11:450–455
doi: 10.1200/JOP.2014.002733
Ko BS, Ahn S, Lee Y-S, Kim WY, Lim KS, Lee J-L (2015) Impact of time to antibiotics on outcomes of chemotherapy-induced febrile neutropenia. Support Care Cancer 23:2799–2804
doi: 10.1007/s00520-015-2645-5
Koea JB, Shaw JH (1989) Surgical management of neutropenic enterocolitis. Br J Surg 76:821–824
doi: 10.1002/bjs.1800760821
Dumont F, Goéré D, Honoré C, Elias D (2015) Abdominal surgical emergencies in patients with advanced cancer. J Visc Surg 152:S91-96
doi: 10.1016/j.jviscsurg.2015.09.014
Brodin P, Gilg S, Lundell L, Mattsson J (2012) Major surgery in a neutropenic patient undergoing allogeneic stem cell transplantation for high risk myelofibrosis. Int J Hematol 96:798–800
doi: 10.1007/s12185-012-1178-7