Surgical Outcomes of Hyperthermic Intraperitoneal Chemotherapy: Analysis of the American College of Surgeons National Surgical Quality Improvement Program

JAMA Surg. 2014 Feb;149(2):170-5. doi: 10.1001/jamasurg.2013.3640.

Abstract

Importance: Hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery have been shown to benefit selected patients with peritoneal carcinomatosis. However, these procedures are associated with high morbidity and mortality. Available data investigating the outcomes of HIPEC are mostly limited to single-center studies. To date, there have been few large-scale studies investigating the postoperative outcomes of HIPEC.

Objective: To determine the associated 30-day morbidity and mortality of cytoreductive surgery-HIPEC in the treatment of metastatic and primary peritoneal cancer in American College of Surgeons National Surgical Quality Improvement Program centers.

Design, setting, and participants: A retrospective review of HIPEC cases performed for primary and metastatic peritoneal cancer diagnoses was conducted. The cytoreductive surgical procedures were sampled, and disease processes were identified. Patient demographics, intraoperative occurrences, and postoperative complications were reviewed from the American College of Surgeons National Surgical Quality Improvement Program from 2005-2011.

Main outcomes and measures: Thirty-day mortality and morbidity.

Results: Of the cancers identified among the 694 sampled cases, 14% of patients had appendiceal cancer, 11% had primary peritoneal cancer, and 8% had colorectal cancer. The American Society of Anesthesiologists classification was 3 for 70% of patients. The average operative time was 7.6 hours, with 15% of patients requiring intraoperative transfusions. Postoperative bleeding (17%), septic shock (16%), pulmonary complications (15%), and organ-space infections (9%) were the most prevalent postoperative complications. The average length of stay was 13 days, with a 30-day readmission rate of 11%. The rate of reoperation was 10%, with an overall mortality rate of 2%.

Conclusions and relevance: American College of Surgeons National Surgical Quality Improvement Program hospitals performing HIPEC have acceptable rates of morbidity and mortality.

MeSH terms

  • Chemotherapy, Cancer, Regional Perfusion / methods
  • Digestive System Surgical Procedures / methods
  • Digestive System Surgical Procedures / standards*
  • Female
  • Follow-Up Studies
  • Hospital Mortality / trends
  • Humans
  • Hyperthermia, Induced / methods*
  • Kaplan-Meier Estimate
  • Length of Stay / trends
  • Male
  • Middle Aged
  • Peritoneal Neoplasms / mortality
  • Peritoneal Neoplasms / therapy*
  • Quality Improvement*
  • Retrospective Studies
  • Survival Rate / trends
  • Treatment Outcome
  • United States / epidemiology