Skip to main content
SpringerLink
Log in

Outcomes Following Major Oncologic Operations for Non-AIDS-Defining Cancers in the HIV Population: A Matched Comparison to the General Population

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Introduction

Human immunodeficiency virus (HIV) patients are living longer due to the availability of antiretroviral therapies, and non-AIDS-defining cancers are becoming more prevalent in this patient population. A paucity of data remains on post-operative outcomes following resection of non-AIDS-defining cancers in the HIV population.

Methods

The National Inpatient Sample was utilized to identify patients who underwent surgical resection for malignancy from 2005 to 2015 (HIV, N = 52,742; non-HIV, N = 11,885,184). Complications were categorized by international classification of disease (ICD)-9 diagnosis codes. Cohorts were matched on insurance, household income, zip code and urban/rural setting. Logistic regression assessed whether HIV was an independent predictor of post-operative complications.

Results

Descriptive statistics found HIV patients to have an increased rate of complications following select oncologic surgical resections. Univariate and multivariate logistic regression found HIV to only be an independent predictor of complications following pulmonary lobectomy (p = 0.011; OR 2.93, 95% CI 1.29–6.73). Length of stay was statistically longer following colectomy (2.61 days, 95% CI 1.98–3.44) in those with HIV.

Conclusions

Our findings are hypothesis generating and highlight the potential safety of major cancer surgery in the HIV population. However, care providers need be cognizant of the potential increased risk of post-operative complications following pulmonary lobectomy and the potential for increased length of stay. These findings are an initial insight into quality of care and outcomes metrics on HIV patients undergoing major cancer operations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Centers for Disease Control and Prevention (2018) Estimated HIV incidence and prevalence in the United States, 2010–2015. HIV Surveillance Supplemental Report 2018;23(No. 1). https://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Accessed 8 Nov 2018.

  2. HIV-Causal Collaboration (2010) The effect of combined antiretroviral therapy on the overall mortality of HIV-infected individuals. AIDS 24:123

    Article  Google Scholar 

  3. Hogg RS, Heath KV, Yip B et al (1998) Improved survival among HIV-infected individuals following initiation of antiretroviral therapy. JAMA 279:450–454

    Article  CAS  Google Scholar 

  4. UNAIDS (2018) Fact Sheet—World AIDS day 2018. https://www.unaids.org/en/resources/fact-sheet. Accessed 8 Nov 2018.

  5. Centers for Disease Control and Prevention (2016) Diagnoses of HIV infection among adults aged 50 years and older in the United States and dependent areas, 2010–2014. HIV Surveillance Supplemental Report 2016;21(No. 2). https://www.cdc.gov/hiv/library/reports/surveillance/. Accessed 8 Nov 2018.

  6. Samji H, Cescon A, Hogg RS et al (2013) Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PloS One 8:e81355

    Article  Google Scholar 

  7. Smith CJ, Ryom L, Weber R et al (2014) Trends in underlying causes of death in people with HIV from 1999 to 2011 (D: A: D): a multicohort collaboration. The Lancet 384:241–248

    Article  Google Scholar 

  8. Robbins HA, Shiels MS, Pfeiffer RM et al (2014) Epidemiologic contributions to recent cancer trends among HIV-infected people in the United States. AIDS 28:881

    Article  Google Scholar 

  9. Stebbing J, Krown SE, Bower M et al (2010) Primary esophageal carcinoma in the era of highly active antiretroviral therapy. Arch Intern Med 170:203–207

    Article  Google Scholar 

  10. Grulich AE (2009) Cancer: the effects of HIV and antiretroviral therapy, and implications for early antiretroviral therapy initiation. Curr Opin HIV AIDS 4:183–187

    Article  Google Scholar 

  11. Zhang YX, Gui XE, Zhong YH et al (2011) Cancer in cohort of HIV-infected population: prevalence and clinical characteristics. J Cancer Res Clin 137:609–614

    Article  Google Scholar 

  12. Grulich AE, Van Leeuwen MT, Falster MO et al (2007) Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis. The Lancet 370:59–67

    Article  Google Scholar 

  13. Patel P, Hanson DL, Sullivan PS et al (2008) Incidence of types of cancer among HIV-infected persons compared with the general population in the United States, 1992–2003. Ann Intern Med 148:728–736

    Article  Google Scholar 

  14. Suneja G, Coghill A (2017) Cancer care disparities in people with HIV in the United States. Curr Opin HIV AIDS 12:63–68

    Article  Google Scholar 

  15. Biggar RJ, Engels EA, Ly S et al (2005) Survival after cancer diagnosis in persons with AIDS. J Acquir Immune Defic Syndr 39:293–9

    Article  Google Scholar 

  16. Suneja G, Lin CC, Simard EP, Han X, Engels EA, Jemal A (2016) Disparities in cancer treatment among patients infected with the human immunodeficiency virus. Cancer 122:2399–2407

    Article  CAS  Google Scholar 

  17. Hooker CM, Meguid RA, Hulbert A et al (2012) Human immunodeficiency virus infection as a prognostic factor in surgical patients with non-small cell lung cancer. Ann Thorac Surg 93:405–412

    Article  Google Scholar 

  18. Suneja G, Shiels MS, Melville SK, Williams MA, Rengan R, Engels EA (2013) Disparities in the treatment and outcomes of lung cancer among HIV-infected individuals. AIDS 27:459

    Article  Google Scholar 

  19. Rengan R, Mitra N, Liao K, Armstrong K, Vachani A (2012) Effect of HIV on survival in patients with non-small-cell lung cancer in the era of highly active antiretroviral therapy: a population-based study. Lancet Oncol 13:1203–1209

    Article  Google Scholar 

  20. Montoto S, Shaw K, Okosun J et al (2012) HIV status does not influence outcome in patients with classical Hodgkin lymphoma treated with chemotherapy using doxorubicin, bleomycin, vinblastine, and dacarbazine in the highly active antiretroviral therapy era. J Clin Oncol 30:4111

    Article  Google Scholar 

  21. Suneja G, Boyer M, Yehia BR et al (2015) Cancer treatment in patients with HIV infection and non-AIDS-defining cancers: a survey of US oncologists. J Oncol Pract 11:e380–e387

    Article  Google Scholar 

  22. Suneja G, Shiels MS, Angulo R et al (2014) Cancer treatment disparities in HIV-infected individuals in the United States. J Clin Oncol 32:2344

    Article  Google Scholar 

  23. Coghill AE, Pfeiffer RM, Shiels MS, Engels EA (2017) Excess mortality among HIV-infected individuals with cancer in the United States. Cancer Epidemol Biomark 26:1027–1033

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Saint Barnabas Medical Center, RWJBarnabas Health, Livingston, NJ, USA

    Amber Chi, Joanna Sesti, Subroto Paul, Amber L. Turner, David August, Darren Carpizo, Timothy Kennedy, Miral Grandhi, H. Richard Alexander, Stuart Geffner & Russell C. Langan

  2. Department of Mathematical Sciences, United States Military Academy, West Point, NY, USA

    Bryan E. Adams

  3. Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA

    David August, Darren Carpizo, Timothy Kennedy, Miral Grandhi, H. Richard Alexander, Steven K. Libutti & Russell C. Langan

Authors
  1. Amber Chi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bryan E. Adams
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joanna Sesti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Subroto Paul
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Amber L. Turner
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David August
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Darren Carpizo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Timothy Kennedy
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Miral Grandhi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. H. Richard Alexander
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Steven K. Libutti
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Stuart Geffner
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Russell C. Langan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

We certify that all individuals who qualify as authors have been listed; each author has participated in one or more of the following areas: conception and design of this work, the acquisition and/or analysis of data and the writing, and/or critical revision of the document. All contributing authors approve of the submission of this version of the manuscript and assert that the document represents valid work. If information derived from another source was used in this manuscript, we made appropriate acknowledgements in the document. All contributing authors take public responsibility for this work.

Corresponding author

Correspondence to Russell C. Langan.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendices

Appendix 1: Type of procedures with statistically increased complication rates

 

Code and procedure

Colon

 Non-HIV-4.1 million

 HIV-11,524

17.33—Laparoscopic right hemicolectomy

17.35—Laparoscopic left hemicolectomy

17.36—Laparoscopic sigmoidectomy

45.76—Open sigmoidectomy

45.72—Open cecectomy

45.74—Open transverse colectomy

Liver

 Non-HIV-739,989

 HIV-10,131

50.3—Lobectomy of liver

Lung

 Non-HIV-6 million

 HIV-27,087

32.3—Segmental resection of lung

32.4—Lobectomy of lung

Stomach

 Non-HIV-280,928

 HIV-1085

43.5—Partial gastrectomy with anastomosis to esophagus

43.6—Partial gastrectomy with anastomosis to duodenum

43.89—Open partial gastrectomy

43.99—Total gastrectomy

Pancreas

 Non-HIV-864,267

 HIV-2915

52.52—distal pancreatectomy

Appendix 2: ICD-9 comorbidity, procedure and complications codes used for data collection

 

ICD-9 code

Cancer diagnoses

Esophagus: 150.0, 150.1, 150.2, 150.3, 150.4, 150.5, 150.6, 150.7, 150.8, 150.9

Stomach: 151.0, 151.1, 151.2, 151.3, 151.4, 151.5, 151.6, 151.8, 151.9

Colon: 153.0, 153.1, 153. 2, 153. 3, 153. 4, 153. 5, 153.6, 153.7, 153.8, 153.9

Rectum: 154.0, 154.1, 154.2, 154.3, 154.8

Pancreas: 157.0, 157.1, 157.2, 157.3, 157.4, 157.8, 157.9

Liver: 155.0, 155.1, 156.1

Lung: 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9

Procedures

Colorectal: 45.4, 45.5, 45.7, 45.8, 45.9, 46.0, 46.1, 46.2, 48.4, 48.5, 48.6, 48.9

Esophageal: 42.4, 42.5, 42.6

Gastric: 43.5, 43.6, 43.7, 43.9

Hepatobiliary: 50.3, 50.4, 51.39, 52.5, 52.6, 52.7

Lung: 32.3, 32.4, 32.5

Pancreatic: 52.0, 52.5, 52.6, 52.7

Comorbidities

305.1, 786.0, V46.0, 491.21, 789.5, 401.9, V45.11, 199.0, 879.8, V58.65, 783.21, 289.9, 286.9, 414.01, 250.03, 250.10, 428.0, 244.8, 276.9, 280.0, 285.9, 443.9, 571, 571.0, 571.1, 571.3, 571.4, 571.5, 571.6, 571.8, 571.9, 572.8, 585.9, 584.9, 042, 070.70, 278.00, 305.00, 305.90, 285.9, 311.0, 435.9, V12.54, 437.0, 438.14, 456.1, 456.2, 410.9, 440.22, 342.9, 344.1, 99.0, V58.2, 285.3, V58.11, 990.0, V58.0, 995.91

Mortality

042, 043, 044, 001, 002, 003, 005, 020, 021, 022, 023, 024, 025, 026, 027, 028, 029, 030, 031, 032, 035, 037, 039, 040, 041, 046, 047, 048, 049, 050, 051, 052, 053, 054, 056, 057, 058,0 59, 060, 061, 062, 063, 064, 065, 066, 067, 068, 069, 070, 071, 072, 073, 074, 075, 076, 077, 078, 079, 080, 081, 082, 083, 084, 085, 086, 087, 088, 097, 098, 099, 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 125, 126, 127, 128, 129, 130, 131, 132, 133, 134, 135, 136, 139

998.9

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chi, A., Adams, B.E., Sesti, J. et al. Outcomes Following Major Oncologic Operations for Non-AIDS-Defining Cancers in the HIV Population: A Matched Comparison to the General Population. World J Surg 43, 3019–3026 (2019). https://doi.org/10.1007/s00268-019-05151-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-019-05151-3

Search

Navigation