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Postoperative Respiratory Failure Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy is Associated with Volume of Intraoperative Crystalloid Administration and Worse Survival

  • Peritoneal Surface Malignancy
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Postoperative respiratory failure (PRF) is associated with increased morbidity after surgery. This retrospective study explores preoperative and perioperative risk factors associated with PRF in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) and the resultant impact on survival.

Methods

We identified all patients who underwent CRS/HIPEC at our institution between 2007 and 2017. PRF was defined as mechanical ventilation for more than 48 h after surgery or reintubation not related to an additional procedure within the first 30 days postoperatively. The relationship between clinicopathologic variables and PRF was examined using Kaplan–Meier log-rank survival analysis and multivariable Cox regression models with 90-day, 1-year and 5-year overall survival (OS).

Results

Overall, 314 patients underwent CRS/HIPEC, of whom 24 patients (7.6%) developed PRF. On univariable analysis, chronic obstructive pulmonary disease (COPD) was the only preoperative risk factor associated with PRF (p = 0.049). Of the intraoperative risk factors, diaphragmatic resection (p = 0.008), Peritoneal Cancer Index (PCI) > 20 (p < 0.001), and volume of intraoperative crystalloid (p < 0.001) were all associated with PRF. On multivariable Cox regression, only intraoperative crystalloid was significantly associated with PRF (p < 0.001), with a volume above 5.3 L (area under the curve [AUC] 0.77) having a high predictive accuracy for PRF. Five-year OS was significantly decreased in patients with PRF (30.2% vs. 52.6%, hazard ratio 2.6, 95% confidence interval 1.5–4.4; p < 0.001).

Conclusions

Liberal intraoperative crystalloid volume resuscitation is a potential independent, modifiable intraoperative risk factor for PRF following CRS/HIPEC that may contribute to decreased long-term OS.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Mount Sinai West, New York, NY, USA

    Eric Pletcher MS, MD & Da Eun Cha MD

  2. Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Elizabeth Gleeson MPH, MD

  3. Department of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK

    Tali Shaltiel MD, Umut Sarpel MD, Noah Cohen MD, Daniel Labow MD & Benjamin Golas MD

  4. Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Deepa Magge MD

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  1. Eric Pletcher MS, MD
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Correspondence to Eric Pletcher MS, MD.

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Disclosures

Eric Pletcher, Da Eun Cha, Elizabeth Gleeson, Tali Shaltiel, Deepa Magge, Noah Cohen, Umut Sarpel, Daniel Labow, and Benjamin Golas do not have any disclosures to declare.

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Pletcher, E., Cha, D.E., Gleeson, E. et al. Postoperative Respiratory Failure Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy is Associated with Volume of Intraoperative Crystalloid Administration and Worse Survival. Ann Surg Oncol 30, 437–444 (2023). https://doi.org/10.1245/s10434-022-12199-4

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  • DOI: https://doi.org/10.1245/s10434-022-12199-4

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