Splenectomy is an independent risk factor for poorer perioperative outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: an analysis of 936 procedures

Saxena, Akshat; Morris, David L.

doi:10.21037/jgo.2017.07.09

Cited by 4 publications

(2 citation statements)

References 27 publications

(36 reference statements)

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“…31 In regard to splenectomy, it has been shown to be an independent risk factor for postoperative morbidity requiring invasive interventions. 36 Additionally, asplenia is associated with increased morbidity and mortality from infectious complications, 37 likely reducing the chance of TO after CRS-HIPEC in these patients. Logistic regression has traditionally been the most commonly used method to evaluate the association of risk factors with binary surgical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Number of bowel anastomosis, which increases with each bowel resection performed, is a known risk factor for complications after CRS‐HIPEC, as a higher number can increase the risk for prolonged ileus, anastomotic leaks 31 . In regard to splenectomy, it has been shown to be an independent risk factor for postoperative morbidity requiring invasive interventions 36 . Additionally, asplenia is associated with increased morbidity and mortality from infectious complications, 37 likely reducing the chance of TO after CRS‐HIPEC in these patients.…”

Section: Discussionmentioning

confidence: 99%

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A machine learning approach for predicting textbook outcome after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Ashraf Ganjouei,

Romero‐Hernandez,

Wang

et al. 2024

World j. surg.

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IntroductionPeritoneal carcinomatosis is considered a late‐stage manifestation of neoplastic diseases. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS‐HIPEC) can be an effective treatment for these patients. However, the procedure is associated with significant morbidity. Our aim was to develop a machine learning model to predict the probability of achieving textbook outcome (TO) after CRS‐HIPEC using only preoperatively known variables.MethodsAdult patients with peritoneal carcinomatosis and who underwent CRS‐HIPEC were included from a large, single‐center, prospectively maintained dataset (2001–2020). TO was defined as a hospital length of stay ≤14 days and no postoperative adverse events including any complications, reoperation, readmission, and mortality within 90 days. Four models (logistic regression, neural network, random forest, and XGBoost) were trained, validated, and a user‐friendly risk calculator was then developed.ResultsA total of 1954 CRS‐HIPEC procedures for peritoneal carcinomatosis were included. Overall, 13% (n = 258) achieved TO following CRS‐HIPEC procedure. XGBoost and logistic regression had the highest area under the curve (AUC) (0.76) after model optimization, followed by random forest (AUC 0.75) and neural network (AUC 0.74). The top preoperative variables associated with achieving a TO were lower peritoneal cancer index scores, not undergoing proctectomy, splenectomy, or partial colectomy and being asymptomatic from peritoneal metastases prior to surgery.ConclusionThis is a data‐driven study to predict the probability of achieving TO after CRS‐HIPEC. The proposed pipeline has the potential to not only identify patients for whom surgery is not associated with prohibitive risk, but also aid surgeons in communicating this risk to patients.

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Section: Discussionmentioning

confidence: 99%