Trends in Outcomes After Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy

J Surg Res. 2019 Feb;234:240-248. doi: 10.1016/j.jss.2018.09.032. Epub 2018 Oct 12.

Abstract

Background: Hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery (CRS) have been shown to improve clinical outcomes among select patients presenting with peritoneal carcinomatosis. The aim of the present study was to describe temporal trends in clinical outcomes among patients undergoing CRS/HIPEC.

Materials and methods: Patients who underwent CRS/HIPEC were identified using the American College of Surgeons National Surgical Quality Improvement Program databases from 2005 to 2013. A multivariable logistic regression analysis was performed to identify risk factors associated with postoperative morbidity and mortality.

Results: A total of 889 patients were identified who met the inclusion criteria. The most common primary tumor sites were the peritoneum (59.8%), followed by the appendix (13.7%) and colon (6.4%). The median operative time for all patients was 438 min (interquartile range: 328-550); postoperative morbidity was 41.3%, and 2.0% of patients died within 30 d of surgery. Over the time evaluated, a statistically significant decrease was observed in the median operative time (2005 versus 2013, 600 versus 403 min), postoperative morbidity (50.0% versus 36.1%), and length of stay (13.5 versus 8 d; all P < 0.05). On multivariable analysis, age > 65 y (odds ratio [OR] = 1.51; 95% confidence interval [CI]: 1.02-2.24; P = 0.037), a low preoperative hematocrit (OR = 1.66; 95% CI: 1.19-2.33; P = 0.003), and preoperative serum albumin < 3 g/dL (OR = 2.10; 95% CI: 1.13-3.90; P = 0.019) were independently associated with greater odds for developing a postoperative complication and/or postoperative death.

Conclusions: Operative time, postoperative morbidity, and length of stay after CRS/HIPEC were observed to improve over the study period. Careful patient selection may result in favorable outcomes for select patients undergoing CRS/HIPEC.

Keywords: Cytoreductive surgery; HIPEC; Hyperthermic intraperitoneal chemotherapy; Trends.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma / therapy*
  • Chemotherapy, Cancer, Regional Perfusion*
  • Combined Modality Therapy
  • Cytoreduction Surgical Procedures*
  • Databases, Factual
  • Female
  • Humans
  • Hyperthermia, Induced*
  • Logistic Models
  • Male
  • Middle Aged
  • Patient Selection
  • Peritoneal Neoplasms / therapy*
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Risk Factors
  • Treatment Outcome