Major Postoperative Complications Are a Risk Factor for Impaired Survival after CRS/HIPEC

Abstract

Background

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a combined treatment option for well-selected patients with peritoneal carcinomatosis (PC). The study aimed to identify factors influencing cancer-specific survival (CSS) and disease-free survival (DFS).

Methods

Data of 113 patients with colorectal or appendicular carcinomatosis from a single center operated between 2009 and 2014 were retrospectively collected and analyzed. Patients with high-grade tumors received standard perioperative chemotherapy, and patients with low-grade appendix tumors were directly operated. HIPEC was performed after radical CRS.

Results

Patients had carcinomatosis from appendix neoplasms in 63% (71/113), including low-grade and high-grade tumors, and colorectal cancer in 37% (42/113). Complete cytoreduction and HIPEC were possible in 67% of patients. Major morbidity occurred in 10.6% of patients, and mean follow-up was 28 months. For colorectal PC, median CSS and DFS were 40 and 12 months, respectively. Median DFS was 19 months for high-grade appendix tumors, while median CSS has not been reached. All patients with diffuse peritoneal adenomucinosis were still alive at time of analysis; rate of DFS was 96% for these patients after 3 years. Major postoperative complications (Clavien-Dindo IIIB or higher) and positive nodal state were associated with impaired CSS and DFS, while a peritoneal cancer index score of >10 was independently associated with impaired CSS.

Conclusions

CRS/HIPEC offers a survival benefit in well-selected patients with PC. Major postoperative complications affect long-term oncologic outcome of these patients.

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Acknowledgement

The authors thank Dr. René Vonlanthen and Prof. Dr. Philippe Gertsch for their support during the setup of the peritoneal surface malignancy program, and biostatisticians Dr. Dimitri Raptis and Dr. Beate Sick for excellent statistical input.

Disclosure

The authors declare no conflict of interest.

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Correspondence to Kuno Lehmann MD, PhD.

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Schneider, M.A., Eshmuminov, D. & Lehmann, K. Major Postoperative Complications Are a Risk Factor for Impaired Survival after CRS/HIPEC. Ann Surg Oncol 24, 2224–2232 (2017). https://doi.org/10.1245/s10434-017-5821-7

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Keywords

  • Overall Survival
  • Peritoneal Carcinomatosis
  • Peritoneal Cancer Index
  • Major Postoperative Complication
  • Hyperthermic Intraperitoneal Chemotherapy