As with all surgical procedures, complications can occur. Some of these risks and complications are inherent in any operative procedures, especially when general anaesthesia is administered. Complications can cause a prolonged hospitalization stay or discharge with significant home care needs. Every effort will be made to minimize the risk of having a complication; and to help you cope if a problem occurs. Your surgeon will speak to you more about these risks.
Some of the possible complications following this CRS and HIPEC are listed below. Selected complications are explained in detail below. More information will be given to you by your surgeon.
Late postoperative complications
An anastomotic leak can be a very serious complication after the operation that can lead to severe intra-abdominal infection. This may require prolonged hospitalization for intravenous antibiotics or even further surgery. In our experience, the risk of an anastomotic leak is 5%. In rare instances, a leak can present with discharge of intestinal fluid from the operative wound or skin in the form of a fistula (an abnormal passage between two organs in the body or between an organ and the exterior of the body), which will delay recovery and might even require another surgery.
This can occur in 1-3% of patients and in severe cases might require a repeat surgery to stop the bleeding.
Wound infections occur in about 5% of patients. This complication may prolong the hospital stay and delay the healing of the wound. Occasionally your wound may need to be laid open to facilitate with cleaning. Antibiotics will also be given.
Infection within the abdomen can result in abscesses and collections. If these are small, a course of antibiotics is sufficient. However, larger fluid collections will require drainage under radiological guidance or by open surgery.
Chest infection can develop after any major surgery, especially after abdominal operations, this is especially so for patients with pre-existing lung disease, and in smokers. This can prolong the hospital stay requiring intravenous antibiotics and chest physiotherapy. It is essential that you participate fully in your post-operative chest therapy to minimize the risk of a chest infection.
Bladder and sexual dysfunction
The risks of bladder and sexual dysfunction are increased when the surgery entails working within the pelvis. The problems include difficulty passing urine and impotence. The risk increases when radiation is given as part of treatment.
Such complications are rare, but include prolapse (protrude excessively), retraction into the wound and parastomal hernias. This may be managed conservatively, with surgery only becoming necessary if it causes a lot of discomfort and becomes difficult to apply the stoma bag onto the skin. Skin irritation around the stoma may result, especially when the stoma bag is not properly applied and this can be managed with topical creams.
You will be seen by your surgeon and/or medical oncologist at the outpatient unit in the National Cancer Centre Singapore at approximately 1-2 weeks after the surgery, and at least every 3 months thereafter for 1 year. Subsequently the frequency of your visits will decrease if you are well. Systemic chemotherapy will be offered by your medical oncologist if you are suitable. CT scans of your body, along with blood tests may be done at each follow-up visit. Appointments with other medical practitioners may also be arranged for you.
The major centers who perform CRS and HIPEC are mainly in the USA and Europe. To our knowledge, we have one of the largest experience in Asia. The risk of a major complication in these centers ranges from 10 to 45%, while the mortality rate ranges from 0 to 3.5%.
According to data from various centers around the world, the median 5 year survival for patients undergoing CRS and HIPEC for colorectal cancers, ovarian cancers and pseudomyxoma peritonei is 42% (20-51%), 25.4% and 87% respectively.
Since 2001, the Division of Surgical Oncology at the National Cancer Centre Singapore, has performed more than 100 CRS and HIPEC procedures for peritoneal disease from colorectal, ovarian, appendiceal, pseudomyxoma peritonei, primary peritoneal and mesothelioma patients. Our post-operative mortality rate is 2%. Our overall survival rate for 1, 3 and 5 years after CRS and HIPEC is 91.7%, 59.1% and 50.9% respectively.
Subscribe to our mailing list to get the updates to your inbox