{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T12:52:13Z","timestamp":1763643133695,"version":"3.40.5"},"reference-count":29,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T00:00:00Z","timestamp":1614816000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Gastric perforation after cytoreductive surgery (CRS) is an infrequent complication. There is lack of evidence regarding the risk factors for this postoperative complication. The aim of this study was to assess the prevalence of postoperative gastric perforation in patients undergoing CRS for peritoneal carcinomatosis (PC) and to evaluate risk factors predisposing to this complication.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We designed a unicentric retrospective study to identify all patients who underwent an open upfront or interval CRS after a primary diagnosis of PC of different origins between March 2007 and December 2018 at a French Comprehensive Cancer Center. The main outcome was the occurrence of postoperative gastric perforation.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Five hundred thirty-three patients underwent a CRS for PC during the study period and 13 (2.4%) presented a postoperative gastric perforation with a mortality rate of 23% (3\/13). Neoadjuvant chemotherapy was administered in 283 (53.1%) patients and 99 (18.6%) received hyperthermic intraperitoneal chemotherapy (HIPEC). In the univariate analysis, body mass index (BMI), peritoneal cancer index, splenectomy, distal pancreatectomy, and histology were significantly associated with postoperative gastric perforation. After multivariate analysis, BMI (OR [95%CI] = 1.13 [1.05\u20131.22], p = 0.002) and splenectomy (OR [95%CI] = 26.65 [1.39\u2013509.67], p = 0.029) remained significantly related to the primary outcome.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Gastric perforation after CRS is a rare event with a high rate of mortality. While splenectomy and increased BMI are risk factors associated with this complication, HIPEC does not seem to be related. Gastric perforation is probably an ischemic complication due to a multifactorial process. Preventive measures such as preservation of the gastroepiploic arcade and prophylactic suture of the greater gastric curvature require further assessment.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0248205","type":"journal-article","created":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T19:05:08Z","timestamp":1614884708000},"page":"e0248205","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Risk factors for gastric perforation after cytoreductive surgery in patients with peritoneal carcinomatosis: Splenectomy and increased body mass index"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4401-3084","authenticated-orcid":true,"given":"Martina Aida","family":"Angeles","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos","family":"Mart\u00ednez-G\u00f3mez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2199-6188","authenticated-orcid":true,"given":"Mathilde","family":"Del","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federico","family":"Migliorelli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manon","family":"Daix","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana\u00efs","family":"Provendier","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muriel","family":"Picard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean","family":"Ruiz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elodie","family":"Chantalat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H\u00e9l\u00e8ne","family":"Leray","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alejandra","family":"Martinez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laurence","family":"Gladieff","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gw\u00e9na\u00ebl","family":"Ferron","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,3,4]]},"reference":[{"key":"pone.0248205.ref001","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1007\/s00018-017-2663-1","article-title":"The peritoneal \u201csoil\u201d for a cancerous \u201cseed\u201d: a comprehensive review of the pathogenesis of intraperitoneal cancer metastases","volume":"75","author":"J. Miku\u0142a-Pietrasik","year":"2018","journal-title":"Cell. Mol. Life Sci"},{"key":"pone.0248205.ref002","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.ygyno.2013.05.040","article-title":"Survival impact of complete cytoreduction to no gross residual disease for advanced-stage ovarian cancer: A meta-analysis","volume":"130","author":"S.-J. Chang","year":"2013","journal-title":"Gynecol. Oncol"},{"key":"pone.0248205.ref003","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/S1470-2045(05)70539-8","article-title":"New standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome?","volume":"7","author":"P.H. Sugarbaker","year":"2006","journal-title":"Lancet Oncol"},{"key":"pone.0248205.ref004","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.ygyno.2005.05.028","article-title":"The role of cytoreductive surgery in nongenital cancers metastatic to the ovaries","volume":"98","author":"A. Ayhan","year":"2005","journal-title":"Gynecol. Oncol"},{"key":"pone.0248205.ref005","doi-asserted-by":"crossref","first-page":"236","DOI":"10.21037\/atm.2017.03.96","article-title":"Malignant peritoneal mesothelioma: a review","volume":"5","author":"J. Kim","year":"2017","journal-title":"Ann. Transl. Med"},{"key":"pone.0248205.ref006","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1097\/00000658-199501000-00004","article-title":"Peritonectomy Procedures","volume":"221","author":"P.H. Sugarbaker","year":"1995","journal-title":"Ann. Surg"},{"issue":"2020","key":"pone.0248205.ref007","first-page":"556","article-title":"Right diaphragmatic peritonectomy for ovarian carcinomatosis in 10 steps","volume":"30","author":"M.A. Angeles","journal-title":"Int. J. Gynecol. Cancer"},{"key":"pone.0248205.ref008","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.ygyno.2018.12.006","article-title":"En bloc pelvic resection for ovarian carcinomatosis: Hudson procedure in 10 steps","volume":"153","author":"M.A. Angeles","year":"2019","journal-title":"Gynecol. Oncol"},{"key":"pone.0248205.ref009","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1056\/NEJMoa1708618","article-title":"Hyperthermic Intraperitoneal Chemotherapy in Ovarian Cancer","volume":"378","author":"W.J. van Driel","year":"2018","journal-title":"N. Engl. J. Med"},{"key":"pone.0248205.ref010","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1200\/JCO.2003.06.139","article-title":"Surgery Combined With Peritonectomy Procedures and Intraperitoneal Chemohyperthermia in Abdominal Cancers With Peritoneal Carcinomatosis: A Phase II Study","volume":"21","author":"O. Glehen","year":"2003","journal-title":"J. Clin. Oncol"},{"key":"pone.0248205.ref011","doi-asserted-by":"crossref","first-page":"2449","DOI":"10.1200\/JCO.2011.39.7166","article-title":"Early- and Long-Term Outcome Data of Patients With Pseudomyxoma Peritonei From Appendiceal Origin Treated by a Strategy of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy","volume":"30","author":"T.C. Chua","year":"2012","journal-title":"J. Clin. Oncol"},{"key":"pone.0248205.ref012","doi-asserted-by":"crossref","first-page":"6237","DOI":"10.1200\/JCO.2009.23.9640","article-title":"Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Malignant Peritoneal Mesothelioma: Multi-Institutional Experience","volume":"27","author":"T.D. Yan","year":"2009","journal-title":"J. Clin. Oncol"},{"key":"pone.0248205.ref013","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.ygyno.2010.05.031","article-title":"The incidence of major complications after the performance of extensive upper abdominal surgical procedures during primary cytoreduction of advanced ovarian, tubal, and peritoneal carcinomas","volume":"119","author":"D.S. Chi","year":"2010","journal-title":"Gynecol. Oncol"},{"key":"pone.0248205.ref014","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1016\/j.ygyno.2009.03.011","article-title":"Postoperative mortality after primary cytoreductive surgery for advanced stage epithelial ovarian cancer: A systematic review","volume":"114","author":"C.G. Gerestein","year":"2009","journal-title":"Gynecol. Oncol"},{"key":"pone.0248205.ref015","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.ejso.2004.09.011","article-title":"Perioperative morbidity and quality of life in long-term survivors following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy","volume":"31","author":"U. Schmidt","year":"2005","journal-title":"Eur. J. Surg. Oncol"},{"key":"pone.0248205.ref016","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1136\/ijgc-2018-000099","article-title":"Predictive risk factors of acute kidney injury after cytoreductive surgery and cisplatin-based hyperthermic intra-peritoneal chemotherapy for ovarian peritoneal carcinomatosis","volume":"29","author":"M.A. Angeles","year":"2019","journal-title":"Int. J. Gynecol. Cancer"},{"key":"pone.0248205.ref017","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1002\/jso.21546","article-title":"Gastric perforation following cytoreductive surgery with perioperative intraperitoneal chemotherapy","volume":"101","author":"L. Zappa","year":"2010","journal-title":"J. Surg. Oncol"},{"key":"pone.0248205.ref018","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/s12957-017-1114-7","article-title":"Gastric perforation following cytoreductive surgery and perioperative intraperitoneal chemotherapy: a case series of six","volume":"15","author":"L.S. Kyang","year":"2017","journal-title":"World J. Surg. Oncol"},{"key":"pone.0248205.ref019","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1016\/j.ejso.2006.03.002","article-title":"Quantitative prognostic indices in peritoneal carcinomatosis","volume":"32","author":"F.N. Gilly","year":"2006","journal-title":"Eur. J. Surg. Oncol"},{"key":"pone.0248205.ref020","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1002\/jso.2930560409","article-title":"Dissection by electrocautery with a ball tip","volume":"56","author":"P.H. Sugarbaker","year":"1994","journal-title":"J. Surg. Oncol"},{"key":"pone.0248205.ref021","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1002\/cncr.21708","article-title":"Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion","volume":"106","author":"S. Kusamura","year":"2006","journal-title":"Cancer"},{"key":"pone.0248205.ref022","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1016\/j.ejso.2015.11.006","article-title":"Peritonectomy procedures and HIPEC in the treatment of peritoneal carcinomatosis from ovarian cancer: Long-term outcomes and perspectives from a high-volume center","volume":"42","author":"F.C. Mu\u00f1oz-Casares","year":"2016","journal-title":"Eur. J. Surg. Oncol"},{"key":"pone.0248205.ref023","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1002\/jso.23834","article-title":"Delayed presentation of major complications in patients undergoing cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy following hospital discharge","volume":"111","author":"S.B. Bhagwandin","year":"2015","journal-title":"J. Surg. Oncol"},{"key":"pone.0248205.ref024","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1245\/s10434-007-9648-5","article-title":"Safety and Efficacy of Hyperthermic Intraperitoneal Chemoperfusion with High-Dose Oxaliplatin in Patients with Peritoneal Carcinomatosis","volume":"15","author":"W.P. Ceelen","year":"2008","journal-title":"Ann. Surg. Oncol"},{"key":"pone.0248205.ref025","doi-asserted-by":"crossref","first-page":"168","DOI":"10.3109\/00365521.2012.746393","article-title":"Long-term mortality following peptic ulcer perforation in the PULP trial. A nationwide follow-up study","volume":"48","author":"M.H. M\u00f8ller","year":"2013","journal-title":"Scand. J. Gastroenterol"},{"key":"pone.0248205.ref026","doi-asserted-by":"crossref","first-page":"1941","DOI":"10.1245\/s10434-016-5109-3","article-title":"Factors Associated with Readmission After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis","volume":"23","author":"A.S. Martin","year":"2016","journal-title":"Ann. Surg. Oncol"},{"key":"pone.0248205.ref027","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1007\/s00276-016-1746-2","article-title":"Vascular anatomy of the stomach related to resection procedures strategy","volume":"39","author":"V. Prudius","year":"2017","journal-title":"Surg. Radiol. Anat"},{"key":"pone.0248205.ref028","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2014\/638936","article-title":"Obesity and Surgical Wound Healing: A Current Review","volume":"2014","author":"Y.N. Pierpont","year":"2014","journal-title":"ISRN Obes"},{"key":"pone.0248205.ref029","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1056\/NEJM198904133201504","article-title":"A Randomized Trial of Nonoperative Treatment for Perforated Peptic Ulcer","volume":"320","author":"T.J. Crofts","year":"1989","journal-title":"N. Engl. J. Med"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0248205","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T19:05:27Z","timestamp":1614884727000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0248205"}},"subtitle":[],"editor":[{"given":"Wen-Chi","family":"Chou","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,3,4]]},"references-count":29,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,3,4]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0248205","relation":{},"ISSN":["1932-6203"],"issn-type":[{"type":"electronic","value":"1932-6203"}],"subject":[],"published":{"date-parts":[[2021,3,4]]}}}