Morbidity and Mortality of Cytoreduction with Intraperitoneal Chemotherapy: Outcomes from the ACS NSQIP Database
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Cytoreduction with intraperitoneal chemotherapy (IPC) for treatment of peritoneal surface malignancies is increasingly utilized. However, the described morbidity and mortality rates are based predominantly on the experience at high-volume centers. We analyzed the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database for a nationwide perspective on morbidity and mortality associated with IPC.
The NSQIP database was queried for all patients undergoing IPC and cytoreduction from 2005 to 2011. Univariate and forward stepwise multivariate regression identified factors associated with 30-day death and morbidity.
A total of 795 patients underwent IPC. Patients underwent a median of seven operative procedures (range 2–13). Median hospital stay was 9 days (range 2–79 days). A total of 521 complications occurred in 249 (31 %) patients, and there were 19 (2.3 %) mortalities. The most common complications were bleeding (15.1 %) and sepsis (14.6 %). Univariate analysis identified age ≥60 years, ascites, weight loss, recent prior operation, albumin <3 g/dl, bilirubin ≥2 mg/dl, hematocrit ≤30 %, colon, spleen, small bowel, liver, kidney, diaphragm, and gastric resections, wound classification, operative time, and intraoperative transfusion requirement as significantly associated with death and morbidity. By multivariate analysis, age ≥60 years, preoperative albumin <3 g/dl, gastrectomy, operative time, and intraoperative transfusion requirement remained significantly associated with death and morbidity. Particularly high death and morbidity rates were associated with preoperative albumin <3 g/dl (58 %), gastrectomy (62 %), and operative time of >500 min (46 %).
In this nationwide cohort, the death and morbidity rate associated with cytoreduction and IPC is consistent with other large series. Age ≥60 years, albumin <3 g/dl, gastrectomy, operative time, and intraoperative transfusion requirement were associated with 30-day death and morbidity. These factors may help guide patient selection, counseling, and preoperative optimization before IPC.
- Sugarbaker, PH (1989) Surgical treatment of peritoneal carcinomatosis: 1988 Du Pont lecture. Can J Surg. 32: pp. 164-170
- Chua, TC, Moran, BJ, Sugarbaker, PH (2012) 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. J Clin Oncol. 30: pp. 2449-2456 CrossRef
- Glehen, O, Osinsky, D, Cotte, E (2003) Intraperitoneal chemohyperthermia using a closed abdominal procedure and cytoreductive surgery for the treatment of peritoneal carcinomatosis: morbidity and mortality analysis of 216 consecutive procedures. Ann Surg Oncol. 10: pp. 863-869 CrossRef
- Kusamura, S, Younan, R, Baratti, D (2006) Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion: analysis of morbidity and mortality in 209 peritoneal surface malignancies treated with closed abdomen technique. Cancer. 106: pp. 1144-1153 CrossRef
- Levine, EA (2007) Stewart JHt, Russell GB, et al. Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy for peritoneal surface malignancy: experience with 501 procedures. J Am Coll Surg. 204: pp. 943-953 CrossRef
- Smeenk, RM, Verwaal, VJ, Zoetmulder, FA (2007) Learning curve of combined modality treatment in peritoneal surface disease. Br J Surg. 94: pp. 1408-1414 CrossRef
- Sugarbaker, PH, Alderman, R, Edwards, G (2006) Prospective morbidity and mortality assessment of cytoreductive surgery plus perioperative intraperitoneal chemotherapy to treat peritoneal dissemination of appendiceal mucinous malignancy. Ann Surg Oncol. 13: pp. 635-644 CrossRef
- Yang, XJ, Huang, CQ, Suo, T (2011) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy improves survival of patients with peritoneal carcinomatosis from gastric cancer: final results of a phase III randomized clinical trial. Ann Surg Oncol. 18: pp. 1575-1581 CrossRef
- Verwaal, VJ, Bruin, S, Boot, H (2008) 8-year follow-up of randomized trial: cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer. Ann Surg Oncol. 15: pp. 2426-2432 CrossRef
- Verwaal, VJ, Ruth, S, Bree, E (2003) Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol. 21: pp. 3737-3743 CrossRef
- Elias, D, Delperro, JR, Sideris, L (2004) Treatment of peritoneal carcinomatosis from colorectal cancer: impact of complete cytoreductive surgery and difficulties in conducting randomized trials. Ann Surg Oncol. 11: pp. 518-521 CrossRef
- Chua, TC, Yan, TD, Saxena, A, Morris, DL (2009) Should the treatment of peritoneal carcinomatosis by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy still be regarded as a highly morbid procedure? A systematic review of morbidity and mortality. Ann Surg. 249: pp. 900-907 CrossRef
- Stephens, AD, Alderman, R, Chang, D (1999) Morbidity and mortality analysis of 200 treatments with cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy using the coliseum technique. Ann Surg Oncol. 6: pp. 790-796 CrossRef
- Gusani, NJ, Cho, SW, Colovos, C (2008) Aggressive surgical management of peritoneal carcinomatosis with low mortality in a high-volume tertiary cancer center. Ann Surg Oncol. 15: pp. 754-763 CrossRef
- Kusamura, S, Baratti, D, Deraco, M (2012) Multidimensional analysis of the learning curve for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in peritoneal surface malignancies. Ann Surg. 255: pp. 348-356 CrossRef
- American College of Surgeons National Surgical Quality Improvement Program. http://site.acsnsqip.org/.
- Americal College of Surgeons National Surgical Quality Improvement Program. User guide for the 2010 participant use data file. http://site.acsnsqip.org/wp-content/uploads/2012/03/2010-User-Guide_FINAL.pdf.
- Daley, J, Forbes, MG, Young, GJ (1997) Validating risk-adjusted surgical outcomes: site visit assessment of process and structure. National VA Surgical Risk Study. J Am Coll Surg. 185: pp. 341-351
- Raval, MV, Hamilton, BH, Ingraham, AM (2011) The importance of assessing both inpatient and outpatient surgical quality. Ann Surg. 253: pp. 611-618 CrossRef
- Shiloach, M, Frencher, SK, Steeger, JE (2009) Toward robust information: data quality and inter-rater reliability in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg. 210: pp. 6-16 CrossRef
- StataCorp. Stata/IC 12.0 statistical software. College Station, TX: StataCorp; 1985–2011. http://www.stata.com.
- Systems, Circle (2011) Stat/Transfer: version 11. Circle Systems Inc., Seattle
- Juul, SFM (2010) An introduction to Stata for health researchers. StataCorp, College Station
- Aloia, TA, Fahy, BN, Fischer, CP (2009) Predicting poor outcome following hepatectomy: analysis of 2313 hepatectomies in the NSQIP database. HPB (Oxford). 11: pp. 510-515 CrossRef
- Greenblatt, DY, Kelly, KJ, Rajamanickam, V (2011) Preoperative factors predict perioperative morbidity and mortality after pancreaticoduodenectomy. Ann Surg Oncol. 18: pp. 2126-2135 CrossRef
- Grossmann, EM, Longo, WE, Virgo, KS (2002) Morbidity and mortality of gastrectomy for cancer in Department of Veterans Affairs medical centers. Surgery. 131: pp. 484-490 CrossRef
- Gill, RS, Al-Adra, DP, Nagendran, J (2011) Treatment of gastric cancer with peritoneal carcinomatosis by cytoreductive surgery and HIPEC: a systematic review of survival, mortality, and morbidity. J Surg Oncol. 104: pp. 692-698 CrossRef
- Piso, P, Slowik, P, Popp, F (2009) Safety of gastric resections during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis. Ann Surg Oncol. 16: pp. 2188-2194 CrossRef
- Morbidity and Mortality of Cytoreduction with Intraperitoneal Chemotherapy: Outcomes from the ACS NSQIP Database
Annals of Surgical Oncology
Volume 21, Issue 5 , pp 1494-1500
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