Annals of Surgical Oncology

, Volume 21, Issue 12, pp 3963–3969 | Cite as

Does Obesity Affect Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion for Disseminated Mucinous Appendiceal Neoplasms?

  • Patricio M. PolancoEmail author
  • Alvaro I. Sanchez
  • Lekshmi Ramalingam
  • Heather Jones
  • Amer Zureikat
  • Matthew Holtzman
  • Steven Ahrendt
  • James Pingpank
  • Herbert J. Zeh
  • David L. Bartlett
  • Haroon A. Choudry
Gastrointestinal Oncology



Obesity has been described as a risk factor for surgical complications and may play a prominent role in the progression, recurrence, and survival rates of various cancers. Our objective was to investigate the impact of being overweight or obese on perioperative and oncologic outcomes after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC) for peritoneal carcinomatosis (PC) from mucinous appendiceal neoplasms (MAN).


From a prospectively maintained database (2001–2010) of CRS/HIPEC for PC from MAN, we evaluated the body mass index (BMI) of patients, categorizing them into normal weight (NW < 25 kg/m2), overweight (OW = 25 to 29.9 kg/m2), and obese (OB ≥ 30 kg/m2). We compared the perioperative and oncologic outcomes among groups.


Of the 282 patients in the database, 234 had BMI data available, and 81, 79, and 74 patients were categorized as NW, OW, and OB, respectively. Although there was a trend toward increased risk of overall complications, wound infections, deep vein thrombosis, respiratory and renal complications, and anastomotic leaks in the OW and OB groups, these differences only achieved statistical significance for renal (p = 0.03) and pulmonary (p = 0.02) complications in the OW and OB groups, respectively. The 5-year survival rate for NW, OW, and OB patients was 63.9, 48, and 54.4 %, respectively (p = 0.63). The median time to progression was 21.1 (NW), 21.7 (OW), and 23.9 (OB) months (p = 0.83).


OW and OB patients may have an increased risk of renal and pulmonary complications, respectively. Obesity has no major impact on perioperative mortality and long-term oncologic outcomes in patients undergoing CRS/HIPEC for MAN.


Body Mass Index Peritoneal Carcinomatosis Body Mass Index Category Body Mass Index Group Complete Cytoreduction 
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.





  1. 1.
    Austin F, Mavanur A, Sathaiah M, Steel J, Lenzner D, Ramalingam L, et al. Aggressive management of peritoneal carcinomatosis from mucinous appendiceal neoplasms. Ann Surg Oncol. 2012;19:1386–93.PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Loungnarath R, Causeret S, Bossard N, Faheez M, Sayag-Beaujard AC, Brigand C, et al. Cytoreductive surgery with intraperitoneal chemohyperthermia for the treatment of pseudomyxoma peritonei: a prospective study. Dis Colon Rectum. 2005;48:1372–9.PubMedCrossRefGoogle Scholar
  3. 3.
    McBride K, McFadden D, Osler T. Improved survival of patients with pseudomyxoma peritonei receiving intraperitoneal chemotherapy with cytoreductive surgery: a systematic review and meta-analysis. J Surg Res. 2013;183:246–52.PubMedCrossRefGoogle Scholar
  4. 4.
    Sugarbaker PH. New standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome? Lancet Oncol. 2006;7:69–76.PubMedCrossRefGoogle Scholar
  5. 5.
    Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010;303:235–41.PubMedCrossRefGoogle Scholar
  6. 6.
    Causey MW, Johnson EK, Miller S, Martin M, Maykel J, Steele SR. The impact of obesity on outcomes following major surgery for Crohn’s disease: an American College of Surgeons National Surgical Quality Improvement Program assessment. Dis Colon Rectum. 2011;54:1488–95.PubMedCrossRefGoogle Scholar
  7. 7.
    Pessaux P, Muscari F, Ouellet JF, Msika S, Hay JM, Millat B, et al. Risk factors for mortality and morbidity after elective sigmoid resection for diverticulitis: prospective multicenter multivariate analysis of 582 patients. World J Surg. 2004;28:92–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Demark-Wahnefried W, Platz EA, Ligibel JA, Blair CK, Courneya KS, Meyerhardt JA, et al. The role of obesity in cancer survival and recurrence. Cancer Epidemiol Biomarkers Prev. 2012;21:1244–59.PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Wisse BE, Kim F, Schwartz MW. Physiology. An integrative view of obesity. Science. 2007;318:928–9.Google Scholar
  10. 10.
    Bao P, Bartlett D. Surgical techniques in visceral resection and peritonectomy procedures. Cancer J. 2009;15:204–11.PubMedCrossRefGoogle Scholar
  11. 11.
    Gusani NJ, Cho SW, Colovos C, Seo S, Franko J, Richard SD, et al. Aggressive surgical management of peritoneal carcinomatosis with low mortality in a high-volume tertiary cancer center. Ann Surg Oncol. 2008;15:754–63.PubMedCrossRefGoogle Scholar
  12. 12.
    Portilla AG, Shigeki K, Dario B, Marcello D. The intraoperative staging systems in the management of peritoneal surface malignancy. J Surg Oncol. 2008;98:228–31.PubMedCrossRefGoogle Scholar
  13. 13.
    Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res. 1996;82:359–74.PubMedCrossRefGoogle Scholar
  14. 14.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg. 2004;240:205–13.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Gough DB, Donohue JH, Schutt AJ, Gonchoroff N, Goellner JR, Wilson TO, et al. Pseudomyxoma peritonei. Long-term patient survival with an aggressive regional approach. Ann Surg. 1994;219:112–9.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Miner TJ, Shia J, Jaques DP, Klimstra DS, Brennan MF, Coit DG. Long-term survival following treatment of pseudomyxoma peritonei: an analysis of surgical therapy. Ann Surg. 2005;241:300–8.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Baratti D, Kusamura S, Nonaka D, Cabras AD, Laterza B, Deraco M. Pseudomyxoma peritonei: biological features are the dominant prognostic determinants after complete cytoreduction and hyperthermic intraperitoneal chemotherapy. Ann Surg. 2009;249:243–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Cioppa T, Vaira M, Bing C, D’Amico S, Bruscino A, De Simone M. Cytoreduction and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis from pseudomyxoma peritonei. World J Gastroenterol. 2008;14:6817–23.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Elias D, Honore C, Ciuchendea R, Billard V, Raynard B, Lo Dico R, et al. Peritoneal pseudomyxoma: results of a systematic policy of complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Br J Surg. 2008;95:1164–71.Google Scholar
  20. 20.
    Moran B, Baratti D, Yan TD, Kusamura S, Deraco M. Consensus statement on the loco-regional treatment of appendiceal mucinous neoplasms with peritoneal dissemination (pseudomyxoma peritonei). J Surg Oncol. 2008;98:277–82.PubMedCrossRefGoogle Scholar
  21. 21.
    Saxena A, Yan TD, Chua TC, Morris DL. Critical assessment of risk factors for complications after cytoreductive surgery and perioperative intraperitoneal chemotherapy for pseudomyxoma peritonei. Ann Surg Oncol. 2010;17:1291–301.PubMedCrossRefGoogle Scholar
  22. 22.
    Schmidt U, Dahlke MH, Klempnauer J, Schlitt HJ, Piso P. Perioperative morbidity and quality of life in long-term survivors following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Eur J Surg Oncol. 2005;31:53–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Stephens AD, Alderman R, Chang D, Edwards GD, Esquivel J, Sebbag G, et al. Morbidity and mortality analysis of 200 treatments with cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy using the coliseum technique. Ann Surg Oncol. 1999;6:790–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Mullen JT, Davenport DL, Hutter MM, Hosokawa PW, Henderson WG, Khuri SF, et al. Impact of body mass index on perioperative outcomes in patients undergoing major intra-abdominal cancer surgery. Ann Surg Oncol. 2008;15:2164–72.PubMedCrossRefGoogle Scholar
  25. 25.
    Moghaddam AA, Woodward M, Huxley R. Obesity and risk of colorectal cancer: a meta-analysis of 31 studies with 70,000 events. Cancer Epidemiol Biomarkers Prev. 2007;16:2533–47.PubMedCrossRefGoogle Scholar
  26. 26.
    Harriss DJ, Atkinson G, George K, Cable NT, Reilly T, Haboubi N, et al. Lifestyle factors and colorectal cancer risk (1): systematic review and meta-analysis of associations with body mass index. Colorectal Dis. 2009;11:547–63.PubMedCrossRefGoogle Scholar
  27. 27.
    Dignam JJ, Polite BN, Yothers G, Raich P, Colangelo L, O’Connell MJ, et al. Body mass index and outcomes in patients who receive adjuvant chemotherapy for colon cancer. J Natl Cancer Inst. 2006;98:1647–54.PubMedCrossRefGoogle Scholar
  28. 28.
    Votanopoulos KI, Swords DS, Swett KR, Randle RW, Shen P, Stewart JH, et al. Obesity and peritoneal surface disease: Outcomes after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for appendiceal and colon primary tumors. Ann Surg Oncol. 2013;20:3899–904.PubMedCrossRefGoogle Scholar
  29. 29.
    McPartland SJ, Goodman MD. Effect of elevated body mass index on outcomes following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2014;21:1463–7.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Patricio M. Polanco
    • 1
    Email author
  • Alvaro I. Sanchez
    • 1
  • Lekshmi Ramalingam
    • 1
  • Heather Jones
    • 1
  • Amer Zureikat
    • 1
  • Matthew Holtzman
    • 1
  • Steven Ahrendt
    • 1
  • James Pingpank
    • 1
  • Herbert J. Zeh
    • 1
  • David L. Bartlett
    • 1
  • Haroon A. Choudry
    • 1
  1. 1.Division of Surgical OncologyUniversity of PittsburghPittsburghUSA

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