Abstract
Background
It is estimated that 37 % of the U.S. population is obese. It is unknown how obesity influences the operative and survival outcomes of cytoreductive surgery (CRS)/hyperthermic intraperitoneal chemotherapy (HIPEC) procedures.
Methods
A retrospective analysis of a prospective database of 1,000 procedures was performed. Type of malignancy, performance status, resection status, hospital and intensive care unit stay, comorbidities, morbidity, mortality, and survival were reviewed.
Results
A total of 246 patients with body mass index (BMI) of >30 kg/m2 underwent 272 CRS/HIPEC procedures. Ninety-five (38.6 %) were severely obese (BMI > 35 kg/m2). A total of 135 (49.6 %) procedures were performed for appendiceal and 60 (22.1 %) for colon cancer. Median follow-up was 52 months. Both major and minor morbidity were similar for obese and non-obese patients. The 30-day mortality rates for obese and non-obese patients were 1.5 and 2.5 %, respectively. Median intensive care unit and hospital stay were 1 and 9 days, regardless of BMI. The 30-day readmission rate was similar between obese and non-obese patients (24.8 vs. 19.4 %, p = 0.11). Median survival for low-grade appendiceal cancer (LGA) was 76 months for obese patients and 107 months for non-obese patients (p = 0.32). Survival was worse for severely obese patients (median survival 54 months) versus non-obese patients with LGA (p = 0.04). Survival was similar for obese and non-obese patients with peritoneal surface disease (PSD) from colon cancer or high-grade appendiceal cancer.
Conclusions
Obesity does not influence postoperative morbidity or mortality of patients with PSD, regardless of primary tumor. Severe obesity is associated with decreased long-term survival only in patients with LGA primary disease; however, application of CRS/HIPEC still offers meaningful prolongation of life. Obesity should not be considered a contraindication for CRS/HIPEC procedures.
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Votanopoulos, K.I., Swords, D.S., Swett, K.R. et al. Obesity and Peritoneal Surface Disease: Outcomes after Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Appendiceal and Colon Primary Tumors. Ann Surg Oncol 20, 3899–3904 (2013). https://doi.org/10.1245/s10434-013-3087-2
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DOI: https://doi.org/10.1245/s10434-013-3087-2