Joel M Baumgartner1, Thomas G Kwong2, Grace L Ma3, Karen Messer4, Kaitlyn J Kelly2, Andrew M Lowy2. 1. Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA. j1baumgartner@ucsd.edu. 2. Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA. 3. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 4. Cancer Prevention and Control Program, Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA.
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.
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.
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Joel M Baumgartner; Laura Tobin; Sean F Heavey; Kaitlyn J Kelly; Eric J Roeland; Andrew M Lowy Journal: Ann Surg Oncol Date: 2014-08-22 Impact factor: 5.344
Authors: Michael G House; Hiromichi Ito; Mithat Gönen; Yuman Fong; Peter J Allen; Ronald P DeMatteo; Murray F Brennan; Leslie H Blumgart; William R Jarnagin; Michael I D'Angelica Journal: J Am Coll Surg Date: 2010-05 Impact factor: 6.113
Authors: Patricio M Polanco; Ying Ding; Jordan M Knox; Lekshmi Ramalingam; Heather Jones; Melissa E Hogg; Amer H Zureikat; Matthew P Holtzman; James Pingpank; Steven Ahrendt; Herbert J Zeh; David L Bartlett; Haroon A Choudry Journal: Ann Surg Oncol Date: 2014-11-07 Impact factor: 5.344
Authors: David Yu Greenblatt; Kaitlyn J Kelly; Victoria Rajamanickam; Yin Wan; Todd Hanson; Robert Rettammel; Emily R Winslow; Clifford S Cho; Sharon M Weber Journal: Ann Surg Oncol Date: 2011-02-20 Impact factor: 5.344
Authors: Anke M J Kuijpers; Boj Mirck; Arend G J Aalbers; Simon W Nienhuijs; Ignace H J T de Hingh; Martinus J Wiezer; Bert van Ramshorst; Robert J van Ginkel; Klaas Havenga; Andreas J Bremers; Johannes H W de Wilt; Elisabeth A Te Velde; Vic J Verwaal Journal: Ann Surg Oncol Date: 2013-07-30 Impact factor: 5.344
Authors: Pietro Maria Lombardi; D Bernasconi; G L Baiocchi; M Berselli; A Biondi; C Castoro; M Catarci; M Degiuli; U Fumagalli Romario; S Giacopuzzi; F Marchesi; D Marrelli; M Mazzola; S Molfino; S Olmi; S Rausei; F Rosa; R Rosati; F Roviello; S Santi; L Solaini; F Staderini; J Viganò; G Ferrari Journal: Gastric Cancer Date: 2022-07-21 Impact factor: 7.701
Authors: Tiffany C Lee; Koffi Wima; Jeffrey J Sussman; Syed A Ahmad; Jordan M Cloyd; Ahmed Ahmed; Keith Fournier; Andrew J Lee; Sean Dineen; Benjamin Powers; Jula Veerapong; Joel M Baumgartner; Callisia Clarke; Harveshp Mogal; Mohammad Y Zaidi; Shishir K Maithel; Jennifer Leiting; Travis Grotz; Laura Lambert; Ryan J Hendrix; Daniel E Abbott; Courtney Pokrzywa; Andrew M Blakely; Byrne Lee; Fabian M Johnston; Jonathan Greer; Sameer H Patel Journal: J Gastrointest Surg Date: 2019-11-19 Impact factor: 3.452
Authors: Whitney L Guerrero; Gitonga Munene; Paxton V Dickson; Dina Darby; Andrew M Davidoff; Michael G Martin; Evan S Glazer; David Shibata; Jeremiah L Deneve Journal: J Gastrointest Oncol Date: 2018-04