Morbidity, mortality, and oncological outcomes of 401 consecutive cytoreductive procedures with hyperthermic intraperitoneal chemotherapy (HIPEC)

Desantis, M.; Bernard, Jean‐Louis; Casanova, Vincent; Cegarra-Escolano, Marianne; Benizri, Emmanuel; Rahili, Amine; Benchimol, Daniel; Béréder, Jean-Marc

doi:10.1007/s00423-014-1253-z

Cited by 60 publications

(47 citation statements)

References 38 publications

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“…The most common major complications from other large studies include bleeding, sepsis, enteric leak, wound infection, and urinary tract infection. 5,12,16,28 In our series, abscess was the most common major morbidity, whereas grade 3 bleeding or greater, sepsis, enteric leak, wound infection, and urinary tract infections were relatively uncommon. This heterogeneity may be explained by differences in the grading and recording of major complications (Clavien score in our series vs. NCI Common Terminology Criteria for Adverse Events or NSQIP definitions in other studies), differences in the threshold for percutaneous drainage of potentially infected fluid collections, and differences in patient populations or operative techniques.…”

Section: Discussionmentioning

confidence: 63%

“…2,5,13,14,16 This major complication rate is lower than that for other large, open abdominal surgical oncology procedures (17 % after hepatectomy for colorectal liver metastases, 25 27 % after pancreaticoduodenectomy, 26 28 % after gastrectomy 27 ). In addition, two publications from the American College of Surgeons NSQIP have reported the rate for NSQIP-defined complications as 31–32.9 % after CRS-HIPEC.…”

Section: Discussionmentioning

confidence: 88%

“…2,5,12–15 Multiple independent predictors of morbidity and mortality have been identified including age, albumin, prior surgery, gastrectomy, operating time, intraoperative transfusion, extent of disease, HIPEC center, primary tumor site, grade, histology, number of anastomoses, presence of ascites, and HIPEC technique. 2,5,12,14–16 Many of these variables are not known at the time of preoperative evaluation, when risk assessment is most valuable to both patient and physician for selection of the appropriate treatment. Therefore, we sought to determine the preoperative predictors of major postoperative complications after CRS-HIPEC in a high-volume center and to derive a prediction tool from these preoperative risk factors.…”

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confidence: 99%

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

et al. 2015

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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.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 88%

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confidence: 99%

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

et al. 2015

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“…8,13 Therefore, during cytoreduction, it may be more advantageous to sacrifice additional short lengths of bowel than to risk more than one anastomoses. We were surprised to find that in this analysis, the PCI score was not a predictor of GIL, unlike previous reports in the literature.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors and Significance of Gastrointestinal Leak After Cytoreductive Surgery (CRS) with Heated Intraperitoneal Chemotherapy (HIPEC)

et al. 2016

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Background Gastrointestinal leak (GIL) after cytoreductive surgery with heated intraperitoneal chemotherapy (CRS/HIPEC) is associated with significant morbidity and mortality. This study aimed to identify GIL prognostic factors and its impact on overall survival. Methods A retrospective analysis of a prospectively maintained database comprising 1270 CRS/HIPEC procedures was performed. Type of GIL, functional and resection status, morbidity, mortality, and survival were reviewed. Results Gastrointestinal leaks were identified in 8.7% (110/1270) of CRS/HIPEC procedures, including 53 anastomotic leaks (4.2%), 53 hollow viscus perforations (4.2%), and four leaks at unknown sites. The multivariate predictors of leak were Eastern Cooperative Oncology Group (ECOG) functional status (ECOG 1 vs. 0: odds ratio [OR] 2.12, p = 0.009; ECOG 2 vs. 0: OR 2.90, p = 0.004), and number of anastomoses (OR 5.34; p < 0.0001). The in-hospital mortality rate for the GIL cohort was 21.8% (24/110), with a 72% (80/110) reoperation rate. The leak cohort had a higher major morbidity rate (88.3 vs. 23.3%; p < 0.0001), a longer hospital stay (39.0 vs. 9.9 days; p < 0.0001), and a longer intensive care unit (ICU) stay (7.7 vs. 1.7 days; p = 0.0003). After surgical mortality was excluded, the overall survival periods for the leak and no-leak patients with complete cytoreduction were respectively 1.5 and 4.98 years (p = 0.0001). Clinically significant decreases in survival were observed for all primary malignancies. Conclusions Gastrointestinal leak after CRS/HIPEC is a source of significant mortality, with a decrease in overall survival even after complete CRS. Preoperative functional status and number of anastomoses are predictors of leak for CRS/HIPEC patients.

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“…35 Topgül et al, 57 found that 8 of the 27 patients (30%) in the study treated with CRS-HIPEC experienced perioperative morbidity, while one patient had HIPEC-related toxicity (3.9%). In a powerful study by Desantis et al, 38 356 patients underwent 401 consecutive CRS-HIPEC procedures with reported morbidity rates of 12.5% and a procedure mortality rate of 1%. The study concludes that the 1% mortality rate and 12.5% morbidity rate are acceptably low when weighed against overall oncologic survival.…”

Section: The Effect Of Hipec On Gastric Cancer Morbiditymentioning

confidence: 99%

Current perspectives on hyperthermic intraperitoneal chemotherapy in gastric cancer

Smith¹,

Kirkpatrick²,

Thomas³

et al. 2017

GICTT

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Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is an effective treatment in a variety of cancers with peritoneal carcinomatosis (PC), especially in pseudomyxoma peritonei for which it is the standard of care. The data for gastric cancer are not as conclusive. This review discusses the effect of HIPEC on gastric cancer survival, the importance of patient selection, the effect of HIPEC on gastric cancer morbidity, translational research on HIPEC, and other recent research on HIPEC in the setting of gastric cancer and/or peritoneal metastases. CRS-HIPEC has been shown to be superior to either CRS alone or systemic chemotherapy alone in terms of improving survival. CRS-HIPEC seems to be the best current treatment for patients with gastric cancer and peritoneal metastases. The international community has recommended it as the treatment for this disease. Prudent patient selection before CRS-HIPEC is recommended as subgroups of patients have been shown to benefit from the treatment, while others have not. Studies on CRS-HIPEC have shown the procedure to have acceptably low rates of morbidity and peri-and postoperative complications as well as significant reductions in the incidence of ascites associated with PC. Translational research on HIPEC supports its use as prophylaxis for prevention of peritoneal metastasis and demonstrates HIPEC to be both effective and safe. Measurement of the tumor marker carcinoembryonic antigen has been shown to be an effective indicator of future outcomes in gastric cancer treated with CRS-HIPEC. Although the treatment outcomes have improved, even current treatment using CRS-HIPEC for gastric cancer with PC the survival rates can be dismal. Thus, the treatment of advanced gastric cancer with PC is an ongoing field of study and future directions of the treatment of gastric cancer with PC may include the use of intraperitoneal immunotherapy.

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Morbidity, mortality, and oncological outcomes of 401 consecutive cytoreductive procedures with hyperthermic intraperitoneal chemotherapy (HIPEC)

Abstract: The low mortality rate and 12.5 % grade III-IV morbidity of CRS and HIPEC are acceptable when weighed against overall oncologic survival. This multimodal treatment appears feasible for selected patients and trained centers.

Cited by 60 publications

References 38 publications

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

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

Prognostic Factors and Significance of Gastrointestinal Leak After Cytoreductive Surgery (CRS) with Heated Intraperitoneal Chemotherapy (HIPEC)

Current perspectives on hyperthermic intraperitoneal chemotherapy in gastric cancer

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