A Novel Tool for Predicting Major Complications After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy

Abstract

Background Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has an emerging role in the treatment of peritoneal malignancies. The CRS-HIPEC approach has known treatment-related toxicities. This study sought to determine the predictors of major postoperative complications after CRS-HIPEC in a high-volume center. Methods From a single-institution database, this study investigated complications experienced by patients undergoing CRS-HIPEC. Multiple preoperative and operative factors were analyzed for their ability to predict 60-day Clavien grade 3 and greater (major) complications by logistic regression. A predictive model was created from preoperative factors using multivariate logistic regression. The model was tested by Akaike’s information criterion, the Hosmer and Lemeshow Goodness-of-Fit Test, the receiver operating characteristic, and the Youden Index. Results The study evaluated 247 patients undergoing CRS-HIPEC. The primary tumor site was the appendix in 166 cases (67.2 %), the colorectal area in 51 cases (20.6 %), the peritoneum (mesothelioma) in 22 cases (8.9 %), the ovary in 5 cases (2 %), and the small bowel in 3 cases (1.2 %). The median peritoneal cancer index was 14 (range 0–29), and 235 patients (95.1 %) had a complete (CC-0/1) cytoreduction. Major complications occurred for 41 patients (16.6 %), classified as grade 3 in 33 cases (13.4 %), grade 4 in 5 cases (2 %), and grade 5 (deaths) in 3 cases (1.2 %). The factors predictive of major complications in the multivariate analysis were a Charlson Comorbidity Index (CCI) score higher than 0 [odds ratio (OR), 2.505; p = 0.035], presence of preoperative symptoms (OR 1.951; p = 0.064), and prior resection status [no resection or prior CRS-HIPEC (OR 2.087) vs. prior resection without CRS-HIPEC (OR 3.209); p = 0.046]. These variables were used to create a tool predictive of postoperative complications. Conclusion Presence of symptoms, CCI, and prior resection status predict major complications and define a low-risk population after CRS-HIPEC.

Factors associated with thromboembolic events following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

“…The median intensive care unit (ICU) stay and overall hospital stay were 3 and 16 (10.5‐26.5), respectively. The median highest postoperative platelet count was 423 (284‐743) × 10 9 /l; and was encountered at a median of 10 days following surgery. Overall, 90 (46.9%) patients developed postoperative thrombocytosis (>450 × 10 9 /l); of them, 25 (13.0%) experienced extreme thrombocytosis (>1000 × 10 9 /l).…”

“…Previous studies that investigated mortality rates in patients who underwent CRS/HIPEC reported an incidence of 3-10% of all VTE events. 4,9,15 However, most of those studies identified only DVT and PE as VTE, with the occurrence of PSMVT assessed in only a few of them. 8,9 Interestingly, in our cohort, PSMVT was the most common thrombotic complication.…”

Targeting of p32 in peritoneal carcinomatosis with intraperitoneal linTT1 peptide-guided pro-apoptotic nanoparticles

“…Intraperitoneal (IP) chemotherapy is used to achieve an increased concentration of the anticancer drugs in the peritoneal cavity and to reduce systemic exposure [5]. IP therapy using mildly heated drug solutions, Hyperthermic IntraPeritoneal Chemotherapy (HIPEC), further enhances drug penetration into malignant tissue, and combining HIPEC with cytoreductive surgery results in improved efficacy of the treatment [6–9]. Encapsulation of cytotoxic drugs in nanoformulations has been also shown to improve the anticancer effect of IP chemotherapy [10].…”

Early experience with cytoreduction and hyperthermic intraperitoneal chemotherapy at a newly developed center for peritoneal malignancy

“…We were unable to identify any factors associated with major morbidity or mortality, presumably because of the small number of patients, but did observe a higher ICU length of stay in those with a major complication. Recently, a novel tool to predict major morbidity and identify low-risk patients who are likely to benefit from CRS/HIPEC has been described and may be useful during preoperative counseling of patients with PC (28). As a new CRS/HIPEC center, we have also been fortunate to collaborate with St Jude Children's Research Hospital in the management of pediatric and young adult patients with desmoplastic small round cell tumor (DSRCT).…”