Annals of Surgical Oncology

, Volume 25, Issue 3, pp 688–693 | Cite as

The Comprehensive Complication Index: a New Measure of the Burden of Complications After Hyperthermic Intraperitoneal Chemotherapy

  • Sinziana Dumitra
  • Michael O’Leary
  • Mustafa Raoof
  • Mark Wakabayashi
  • Thanh H. Dellinger
  • Ernest S. Han
  • Stephen J. Lee
  • Byrne Lee
Colorectal Cancer
  • 204 Downloads

ABSTRACT

Background

Cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) are complex surgeries with multiple comorbidities. The Clavien–Dindo classification (CDC) is the most commonly used method to report surgical morbidity, but limits it to the highest-grade complication. The Comprehensive Complication Index (CCI) is a score ranging from 0 to 100, calculated using all 30-day complications and their treatment after abdominal surgery. The aim of this study is to assess the CCI’s validity in the HIPEC patient population.

Methods

A review of our institutional cytoreduction database from 2009 to 2015 was undertaken. Patient demographics, pathology, Peritoneal Carcinomatosis Index (PCI), complications and their treatments, and length of stay (LOS) were reviewed. The CCI was calculated for each patient. Linear regression was used to assess whether the CCI and CDC were predictors of LOS.

Results

Of 157 patients reviewed, 110 (70.1%) underwent HIPEC. The majority were female (77, 66.9%), and the mean age was 53.7 years. Mean PCI was 13.2 [interquartile range (IQR) 7–18]. Median CDC was grade 2 (IQR 0–2), and only 9.8% had CDC of grade 4 or higher. Mean CCI was 21.4, while the median was 20.9 (IQR 0–30.8). Mean LOS was 16.2 days, while the median was 11 days (IQR 8–15 days). The CCI strongly correlated with LOS with coefficient of 0.46 [95% confidence interval (CI) 0.38–0.54, p = 0.000].

Conclusions

The CCI is an adequate tool to capture all complications and their overall burden in patients having undergone HIPEC. This study shows that the CCI can predict LOS and could be used to quantify and compare the burden of multiple complications.

Notes

Disclosures

Sinziana Dumitra is recipient of the Shiabata Fellowship, awarded by the Cedar Cancer Foundation, Montreal, Canada.

References

  1. 1.
    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: 900–907.CrossRefPubMedGoogle Scholar
  2. 2.
    Clavien PA, Barkun J, de Oliveira ML et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009; 250: 187–196.CrossRefPubMedGoogle Scholar
  3. 3.
    Clavien PA, Strasberg SM. Severity grading of surgical complications. Ann Surg. 2009; 250: 197–198.CrossRefPubMedGoogle Scholar
  4. 4.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240: 205–213.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Lehmann K, Eshmuminov D, Slankamenac K et al. Where oncologic and surgical complication scoring systems collide: time for a new consensus for CRS/HIPEC. World J Surg. 2016; 40: 1075–1081.CrossRefPubMedGoogle Scholar
  6. 6.
    Winship C MR. Regression models with ordinal variables. Am Sociol Rev. 1984; 49: 13.CrossRefGoogle Scholar
  7. 7.
    Slankamenac K, Graf R, Barkun J et al. The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg. 2013; 258: 1–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Slankamenac K, Nederlof N, Pessaux P et al. The comprehensive complication index: a novel and more sensitive endpoint for assessing outcome and reducing sample size in randomized controlled trials. Ann Surg. 2014; 260: 757–762; discussion 762–753.Google Scholar
  9. 9.
    Slaman AE, Lagarde SM, Gisbertz SS, van Berge Henegouwen MI. A quantified scoring system for postoperative complication severity compared to the Clavien–Dindo classification. Dig Surg. 2015; 32: 361–366.CrossRefPubMedGoogle Scholar
  10. 10.
    Nederlof N, Slaman AE, van Hagen P et al. Using the comprehensive complication index to assess the impact of neoadjuvant chemoradiotherapy on complication severity after esophagectomy for cancer. Ann Surg Oncol. 2016, 23(12):3964–3971.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Marsman EM, de Rooij T, van Eijck CH et al. Pancreatoduodenectomy with colon resection for cancer: a nationwide retrospective analysis. Surgery. 2016; 160: 145–152.CrossRefPubMedGoogle Scholar
  12. 12.
    Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res. 1996; 82: 359–374.CrossRefPubMedGoogle Scholar
  13. 13.
    Harmon RL, Sugarbaker PH. Prognostic indicators in peritoneal carcinomatosis from gastrointestinal cancer. Int Semin Surg Oncol. 2005; 2: 3.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
  15. 15.
    Burnham KP, Anderson DR. Multimodel inference: understanding AIC and BIC in model selection. Sociol Methods Res. 2004; 33: 261.CrossRefGoogle Scholar
  16. 16.
    Jafari MD, Halabi WJ, Stamos MJ, et al. Surgical outcomes of hyperthermic intraperitoneal chemotherapy: analysis of the American College of Surgeons National Surgical Quality Improvement Program. JAMA Surg. 2014; 149: 170–175.CrossRefPubMedGoogle Scholar
  17. 17.
    Elias D, Gilly F, Boutitie F, et al. Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: retrospective analysis of 523 patients from a multicentric French study. J Clin Oncol. 2010; 28: 63–68.CrossRefPubMedGoogle Scholar
  18. 18.
    Elias D, Lefevre JH, Chevalier J, et al. Complete cytoreductive surgery plus intraperitoneal chemohyperthermia with oxaliplatin for peritoneal carcinomatosis of colorectal origin. J Clin Oncol. 2009; 27: 681–685.CrossRefPubMedGoogle Scholar
  19. 19.
    Yan TD, Deraco M, Baratti D et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma: multi-institutional experience. J Clin Oncol. 2009; 27: 6237–6242.CrossRefPubMedGoogle Scholar
  20. 20.
    Martin RC, 2nd, Brennan MF, Jaques DP. Quality of complication reporting in the surgical literature. Ann Surg. 2002; 235: 803–813.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Trotti A, Colevas AD, Setser A et al. CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol. 2003; 13: 176–181.CrossRefPubMedGoogle Scholar
  22. 22.
    Younan R, Kusamura S, Baratti D et al. Morbidity, toxicity, and mortality classification systems in the local regional treatment of peritoneal surface malignancy. J Surg Oncol 2008; 98: 253–257.CrossRefPubMedGoogle Scholar
  23. 23.
    Basch E, Jia X, Heller G et al. Adverse symptom event reporting by patients vs clinicians: relationships with clinical outcomes. J Natl Cancer Inst. 2009; 101: 1624–1632.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Chow A, Mayer EK, Darzi AW, Athanasiou T. Patient-reported outcome measures: the importance of patient satisfaction in surgery. Surgery 2009; 146: 435–443.CrossRefPubMedGoogle Scholar
  25. 25.
    Strasberg SM, Hall BL. Postoperative morbidity index: a quantitative measure of severity of postoperative complications. J Am Coll Surg 2011; 213: 616–626.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  1. 1.Department of SurgeryCity of HopeDuarteUSA

Personalised recommendations