Miguel Ángel Estévez, Spain
Hospital Universitario Son Espases ImmunologyPresenter of 1 Presentation
PATIENTS WITH PERITONEAL CARCINOMATOSIS SUFFER FROM HYPOGAMMAGLOBULINEMIA AFTER CYTOREDUCTIVE SURGERY AND HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY
Abstract
Background and Aims
Peritoneal dissemination is the primary metastatic route of ovarian cancer (OC) and a common progression route of gastrointestinal cancer (GC). Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) represents a potentially curative treatment for peritoneal carcinomatosis. However, these patients suffer from infectious complications after the surgical procedure. We aimed to assess the immunoglobulin(Ig)G, IgA and IgM serum levels in samples obtained before and 24 hours after the CRS-HIPEC procedure. We further correlated these data with the peritoneal cancer index (PCI) of the patients.
Methods
IgG, IgA and IgM levels were determined by nephelometry in ninety patients diagnosed with peritoneal carcinomatosis and treated with CRS-HIPEC. Patients were grouped according to their primary cancer. The extension of peritoneal dissemination was classified using the PCI which is a quantitative indicator of tumour involvement estimated from the size of the tumour nodules and its distribution along the peritoneal surface.
Results
Although, IgG levels were within the normal range before the surgical procedure (840±26 mg/dl), they were lower 24 hours after surgery (490±20 mg/dl; p<0.0001). Similar results were found when OC (890±43 vs. 450±32 mg/dl; p<0.0001) and GC (800±32 vs. 510±26 mg/dl; p<0.0001) were evaluated separately. These results were also similar when IgM and IgA were evaluated. Furthermore, immunoglobulin levels, specially IgG, correlated inversely with the PCI.
Conclusions
CRS-HIPEC can be considered as a new cause of secondary hypogammaglobulinemia. Quantification of serum immunoglobulins might contribute to identify an increased risk of infectious complications in these group of patients, especially in patients with a higher burden of cancer.