Adriana C Gamboa1, Rachel M Lee1, Michael K Turgeon1, Mohammad Y Zaidi1, Charles W Kimbrough2, Travis E Grotz3, Jennifer Leiting3, Keith Fournier4, Andrew J Lee4, Sean P Dineen5, Benjamin D Powers5, Jula Veerapong6, Joel M Baumgartner6, Callisia N Clarke7, Harveshp Mogal7, Sameer H Patel8, Tiffany C Lee8, Laura A Lambert9, Ryan J Hendrix9, Daniel E Abbott10, Courtney Pokrzywa10, Mustafa Raoof11, Oliver S Eng12, Fabian M Johnston13, Jonathan Greer13, Jordan M Cloyd2, Shishir K Maithel14, Charles A Staley1. 1. Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA. 2. Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA. 3. Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, NY, USA. 4. Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA. 5. Department of Gastrointestinal Oncology, Moffitt Cancer Center, Department of Oncologic Sciences, Morsani College of Medicine, Tampa, FL, USA. 6. Division of Surgical Oncology, Department of Surgery, University of California, San Diego, CA, USA. 7. Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA. 8. Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA. 9. Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA. 10. Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI, USA. 11. Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA. 12. Division of Surgical Oncology, Department of Surgery, University of Chicago, Chicago, IL, USA. 13. Department of Surgery, Johns Hopkins University, Baltimore, USA. 14. Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA. smaithe@emory.edu.
Abstract
BACKGROUND: Postoperative complications (POCs) are associated with worse oncologic outcomes in various cancer histologies. The impact of POCs on the survival of patients with appendiceal or colorectal cancer after cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) is unknown. METHODS: The US HIPEC Collaborative (2000-2017) was reviewed for patients who underwent CCR0/1 CRS/HIPEC for appendiceal/colorectal cancer. The analysis was stratified by noninvasive appendiceal neoplasm versus invasive appendiceal/colorectal adenocarcinoma. The POCs were grouped into infectious, cardiopulmonary, thromboembolic, and intestinal dysmotility. The primary outcomes were overall survival (OS) and recurrence-free survival (RFS). RESULTS: Of the 1304 patients, 33% had noninvasive appendiceal neoplasm (n = 426), and 67% had invasive appendiceal/colorectal adenocarcinoma (n = 878). In the noninvasive appendiceal cohort, POCs were identified in 55% of the patients (n = 233). The 3-year OS and RFS did not differ between the patients who experienced a complication and those who did not (OS, 94% vs 94%, p = 0.26; RFS, 68% vs 60%, p = 0.15). In the invasive appendiceal/colorectal adenocarcinoma cohort, however, POCs (63%; n = 555) were associated with decreased 3-year OS (59% vs 74%; p < 0.001) and RFS (32% vs 42%; p < 0.001). Infectious POCs were the most common (35%; n = 196). In Multivariable analysis accounting for gender, peritoneal cancer index (PCI), and incomplete resection (CCR1), infectious POCs in particular were associated with decreased OS compared with no complication (hazard ratio [HR] 2.08; p < 0.01) or other types of complications (HR, 1.6; p < 0.01). Similarly, infectious POCs were independently associated with worse RFS (HR 1.61; p < 0.01). CONCLUSION: Postoperative complications are associated with decreased OS and RFS after CRS/HIPEC for invasive histology, but not for an indolent disease such as noninvasive appendiceal neoplasm, and this association is largely driven by infectious complications. The exact mechanism is unknown, but may be immunologic. Efforts must target best practices and standardized prevention strategies to minimize infectious postoperative complications.
BACKGROUND:Postoperative complications (POCs) are associated with worse oncologic outcomes in various cancer histologies. The impact of POCs on the survival of patients with appendiceal or colorectal cancer after cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) is unknown. METHODS: The US HIPEC Collaborative (2000-2017) was reviewed for patients who underwent CCR0/1 CRS/HIPEC for appendiceal/colorectal cancer. The analysis was stratified by noninvasive appendiceal neoplasm versus invasive appendiceal/colorectal adenocarcinoma. The POCs were grouped into infectious, cardiopulmonary, thromboembolic, and intestinal dysmotility. The primary outcomes were overall survival (OS) and recurrence-free survival (RFS). RESULTS: Of the 1304 patients, 33% had noninvasive appendiceal neoplasm (n = 426), and 67% had invasive appendiceal/colorectal adenocarcinoma (n = 878). In the noninvasive appendiceal cohort, POCs were identified in 55% of the patients (n = 233). The 3-year OS and RFS did not differ between the patients who experienced a complication and those who did not (OS, 94% vs 94%, p = 0.26; RFS, 68% vs 60%, p = 0.15). In the invasive appendiceal/colorectal adenocarcinoma cohort, however, POCs (63%; n = 555) were associated with decreased 3-year OS (59% vs 74%; p < 0.001) and RFS (32% vs 42%; p < 0.001). Infectious POCs were the most common (35%; n = 196). In Multivariable analysis accounting for gender, peritoneal cancer index (PCI), and incomplete resection (CCR1), infectious POCs in particular were associated with decreased OS compared with no complication (hazard ratio [HR] 2.08; p < 0.01) or other types of complications (HR, 1.6; p < 0.01). Similarly, infectious POCs were independently associated with worse RFS (HR 1.61; p < 0.01). CONCLUSION:Postoperative complications are associated with decreased OS and RFS after CRS/HIPEC for invasive histology, but not for an indolent disease such as noninvasive appendiceal neoplasm, and this association is largely driven by infectious complications. The exact mechanism is unknown, but may be immunologic. Efforts must target best practices and standardized prevention strategies to minimize infectious postoperative complications.
Authors: Kevin M Turner; Mackenzie C Morris; Aaron M Delman; Dennis Hanseman; Fabian M Johnston; Jonathan Greer; Kara Vande Walle; Daniel E Abbott; Mustafa Raoof; Travis E Grotz; Keith Fournier; Sean Dineen; Jula Veerapong; Ugwuji Maduekwe; Anai Kothari; Charles A Staley; Shishir K Maithel; Laura A Lambert; Alex C Kim; Jordan M Cloyd; Gregory C Wilson; Jeffrey J Sussman; Syed A Ahmad; Sameer H Patel Journal: J Gastrointest Surg Date: 2022-10-18 Impact factor: 3.267