Annals of Surgical Oncology

, Volume 20, Issue 12, pp 3919–3926 | Cite as

Hemophagocytic Syndrome: An Unusual and Underestimated Complication of Cytoreduction Surgery with Heated Intraperitoneal Oxaliplatin

  • Lilian Schwarz
  • Valerie Bridoux
  • Benoit Veber
  • Eric Oksenhendler
  • Vincent Royon
  • Francis Michot
  • Jean-Jacques Tuech
Gastrointestinal Oncology

Abstract

Background

Hyperthermic intraperitoneal chemotherapy (HIPEC) improves the survival of select patients with peritoneal carcinomatosis. Hemophagocytic syndrome (HS) is a rare and potentially fatal disease. We describe our experience with five patients who developed HS following oxaliplatin HIPEC and propose a management procedure.

Methods

Hyperthermic intraperitoneal chemotherapy was performed using the open-abdomen technique (43 °C) with oxaliplatin (460 mg/m 2 ) for 30 min. If thrombocytopenia occurred from days 5 to 14, heparin-induced thrombocytopenia was evaluated. For thrombocytopenia with unknown etiology, we performed a bone marrow analysis (BMA). A BMA indicating HS stimulated an extensive infectious disease workup. Herein, we describe “reactive septic HS” and HS of unknown origin.

Results

We documented five patients with HS as a result of severe thrombocytopenia. Underlying infections were present in two patients who were treated with antibiotics and survived. For the remaining three patients, we found no underlying etiology of HS; multidisciplinary staff adapted the clinical management daily. Two patients died on postoperative days 40 and 29. The third patient survived after several operations and treatment with the VAC abdominal dressing system.

Conclusions

We present these cases to ensure that physicians are aware of the symptoms of HS after HIPEC, which are important for initiating immediate life-saving therapy. This condition is a diagnostic and therapeutic emergency. When HS complicates HIPEC, aggressive, early medical, and surgical management is required. However, the optimal management has not been defined.

Keywords

Oxaliplatin Severe Thrombocytopenia Peritoneal Cancer Index Hemophagocytic Syndrome Abdominal Sepsis 

Notes

Ethical Standard

The protocol was approved by the institutional review board.

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Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Lilian Schwarz
    • 1
  • Valerie Bridoux
    • 1
  • Benoit Veber
    • 2
  • Eric Oksenhendler
    • 3
  • Vincent Royon
    • 4
  • Francis Michot
    • 1
  • Jean-Jacques Tuech
    • 1
  1. 1.Department of Digestive SurgeryHôpital Charles NicolleRouen CedexFrance
  2. 2.Surgical Intensive Care UnitHôpital Charles NicolleRouen CedexFrance
  3. 3.Department of Clinical Immunology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de ParisUniversity Paris DiderotParisFrance
  4. 4.Department of AnaesthesiologyHôpital Charles NicolleRouen CedexFrance

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