Morbidity and Mortality Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Data from the DGAV StuDoQ Registry with 2149 Consecutive Patients
- 188 Downloads
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are performed for well-selected patients with peritoneal surface malignancies. This combined treatment is potentially associated with an increased rate of complications.
The aim of this paper was to analyze the morbidity and mortality of CRS and HIPEC in the German national registry.
We present a retrospective analysis of 2149 consecutive patients from 52 hospitals. The data were prospectively documented in the DGAV StuDoQ Registry between February 2011 and December 2016.
Almost two-thirds of all patients had a colorectal malignancy; therefore, the most frequently performed resections were colectomies (54%) and rectal resections (30%). Only 36.2% of all patients had no anastomosis, and fewer than 20% of all patients were older than 70 years of age (16.4%). Enteric fistula and anastomotic leaks occurred in 10.5% of all cases. The reoperation rate was 14.6% (95% confidence interval [CI] 11.51–18.1). Major grade 3 and 4 complications (Clavien–Dindo classification) occurred in 19.3% of all patients, half of which were due to surgical complications. The overall 30-day postoperative hospital mortality was 2.3% (95% CI 1.02–3.85). Multivariate analysis showed an increased risk for morbidity associated with pancreatic resections (odds ratio [OR] 2.4), rectal resection (OR 1.5), or at least one anastomosis (OR 1.35), and mortality with reoperation (OR 8.7) or age > 70 years (OR 3.35).
CRS and HIPEC are associated with acceptable morbidity and low mortality. These results show that CRS and HIPEC can be safely performed nationwide when close mentoring by experienced centers is provided.
The authors would like to thank Dr Daniel Leucuta, MSc, PhD, from the Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy, “Iuliu Hatieganu”, Cluj-Napoca, Romania—for having performed the statistical analysis of all recorded data. The Peritoneum Surface Oncology Group and members of the StuDoQ-HIPEC Registry of the German Society for General and Visceral Surgery (DGAV) include the following institutions: Magdeburg Hospital; University Hospital Greifswald; Kempten-Oberallgäu Hospital; Katharinenhospital Stuttgart; University Hospital Würzburg; Hospital Barmherzige Brüder Regensburg; University Hospital Regensburg; University Hospital Charite Berlin Campus Mitte; University Hospital Tübingen; University Hospital Hamburg; University Hospital Schleswig–Holstein, Campus Kiel; Köln-Merheim Medical Center, Witten/Herdecke University; Hospital Dachau; Johanniter-Hospital Bonn; Diakonie Hospital Henriettenstiftung, Hannover; Marienhospital Herne, Ruhr University Hospital, Bochum; Hospital Osnabrück; Helios Hospital Berlin Buch; Asklepios Hospital Wiesbaden; Westpfalz – Hospital Kaiserslautern; Hospital Offenbach; Hospital Robert-Bosch Stuttgart; University Hospital Düsseldorf, Clemenshospital Münster; University Hospital Freiburg; University Hospital Gießen; St. Joseph Hospital Berlin-Tempelhof; Diakonissen Hospital Dresden; Asklepios Hospital Langen; Hospital Frankfurt-Höchst; Hospital Dresden-Friedrichstadt; University Hospital Mainz; Hospital Nordwest, Frankfurt am Main; Vivantes Humboldt Hospital Berlin; Rotkreuz Hospital München; Hospital Arnsberg; University Hospital Jena; Hospital Leverkusen; University Hospital Wien; University Hospital Schleswig-Holstein, Campus Lübeck; University Hospital Charite Berlin, Campus Benjamin Franklin; Hospital Celle; LMU München, Hospital Großhadern; University Hospital Göttingen, University Hospital rechts der Isar TU München; University Hospital Münster; University Hospital Erlangen; Caritas Hospital Saarbrücken; University Hospital Magdeburg; Hospital Sindelfingen-Böblingen; Agaplesion Diakonie Hospital Kassel; Hospital München Bogenhausen; DRK-Hospital Berlin-Köpenick; Hospital Aschaffenburg; Pleißental- Hospital Werdau; Asklepios Hospital Barmbek; Paracelsus Private University Hospital Salzburg, University Hospital Leipzig; Catholic Hospital Essen; Hospital Bremen-Mitte; University Hospital Köln; Rems-Murr Hospital, Schorndorf; AMEOS Hospital Am Bürgerpark, Bremerhaven; University Hospital Olomouc. This manuscript was created with the help of the DGAV StuDoQ Registry (German Society for General and Visceral Surgery) under ID number StuDoQ-2017-0023.
Conflict of interest
On behalf of all authors of this current article, Prof. Dr. Piso declares there are no conflicts of interest with regard to the content of this article.
- 8.Huang CQ, Min Y, Wang SY, et al. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy improves survival for peritoneal carcinomatosis from colorectal cancer: a systematic review and meta-analysis of current evidence. Oncotarget. 2017;8(33):55657–83.Google Scholar
- 9.Newton AD, Bartlett EK, Karakousis GC. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a review of factors contributing to morbidity and mortality. J Gastrointest Oncol. 2016;7(1):99–111Google Scholar
- 11.Jähne J, Piso P, Schmoll E, et al. Intraoperative (hyperthermic) chemotherapy: considerations and aspects of safe intra- and postoperative treatment with cytostatic drugs. Langenbecks Arch Chir. 1997;382:8–14Google Scholar
- 13.Piso P. Bericht aus der Arbeitsgruppe “Primäre und sekundäre Malignome des Peritoneums”. Onkologie. 2005;28:446–7Google Scholar