World Journal of Surgery

, Volume 40, Issue 5, pp 1075–1081 | Cite as

Where Oncologic and Surgical Complication Scoring Systems Collide: Time for a New Consensus for CRS/HIPEC

  • Kuno LehmannEmail author
  • Dilmurodjon Eshmuminov
  • Ksenija Slankamenac
  • Benedict Kranzbühler
  • Pierre-Alain Clavien
  • René Vonlanthen
  • Philippe Gertsch
Original Scientific Report



Morbidity and mortality rates after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are important quality parameters to compare peritoneal surface malignancy centers. A major problem to assess postoperative outcomes among centers is the inconsistent reporting due to two coexisting systems, the diagnose-based common terminology criteria for adverse events (CTCAE) classification and the therapy-oriented Clavien-Dindo classification. We therefore assessed and compared both reporting systems.

Patients and Methods

Complications after CRS/HIPEC were recorded in 147 consecutive patients and independently graded by an expert board using both systems. In a next step, a group of residents, experienced surgeons, and medical oncologists evaluated a set of twelve real complications, either with the Clavien-Dindo or CTCAE classification.


The postoperative complication rate after CRS/HIPEC was 37 % (54/147), 6.8 % (10/147) were reoperated, and three (2 %) patients died. The most frequent complications were intestinal fistula or abscess, pulmonary complications, and ileus. Grading of complications with the CTCAE classification resulted in a significantly higher major morbidity rate compared to the Clavien-Dindo classification (25 vs. 8 %, p = 0.001). Evaluating a set of complications, residents, surgeons, and oncologists correctly assessed significantly more complications with the Clavien-Dindo compared to the CTCEA classification (p < 0.001). In addition, all participants evaluated the Clavien-Dindo classification as more simple. Residents (p < 0.001) and surgeons (p < 0.01) required less time with the Clavien-Dindo classification; there was no difference for oncologist.


In conclusion, our data indicate that there is a different interpretation of severity grades of complications after CRS/HIPEC between the two classifications. There is a need for a common language in the field of CRS/HIPEC, which should be defined by a new consensus to compare surgical outcomes.


Peritoneal Carcinomatosis Intraclass Correlation Coefficient Severity Grade Hyperthermic Intraperitoneal Chemotherapy Peritoneal Surface Malignancy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Common terminology criteria for adverse events


Cytoreductive surgery


Hyperthermic intraperitoneal chemotherapy


Peritoneal carcinomatosis


Peritoneal Cancer Index


Completeness of cytoreduction scoring

Supplementary material

268_2015_3366_MOESM1_ESM.docx (12 kb)
Supplementary material 1 (DOCX 12 kb)


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Copyright information

© Société Internationale de Chirurgie 2015

Authors and Affiliations

  • Kuno Lehmann
    • 1
    Email author
  • Dilmurodjon Eshmuminov
    • 1
  • Ksenija Slankamenac
    • 1
  • Benedict Kranzbühler
    • 1
  • Pierre-Alain Clavien
    • 1
  • René Vonlanthen
    • 1
  • Philippe Gertsch
    • 1
  1. 1.Klinik für Viszeral- und TransplantationschirurgieUniversitätsspital ZürichZurichSwitzerland

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