Morbidity and Mortality of Cytoreduction with Intraperitoneal Chemotherapy: Outcomes from the ACS NSQIP Database
- 1.2k Downloads
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.
KeywordsIntraperitoneal Chemotherapy Gastric Resection High Volume Center National Surgical Quality Improvement Program Pseudomyxoma Peritonei
The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.
The authors declare no conflict of interest.
- 3.Glehen O, Osinsky D, Cotte E, et al. 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. 2003;10:863–9.PubMedCrossRefGoogle Scholar
- 8.Yang XJ, Huang CQ, Suo T, et al. 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. 2011;18:1575–81.PubMedCentralPubMedCrossRefGoogle Scholar
- 12.Chua TC, Yan TD, Saxena A, Morris DL. 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. 2009;249:900–7.PubMedCrossRefGoogle Scholar
- 16.American College of Surgeons National Surgical Quality Improvement Program. http://site.acsnsqip.org/.
- 17.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.
- 21.StataCorp. Stata/IC 12.0 statistical software. College Station, TX: StataCorp; 1985–2011. http://www.stata.com.
- 22.Circle Systems. Stat/Transfer: version 11. Seattle, WA: Circle Systems Inc.; 2011.Google Scholar
- 23.Juul SFM. An introduction to Stata for health researchers. 3rd ed. College Station, TX: StataCorp; 2010. p. 179–96.Google Scholar