1. A Novel Tool for Predicting Major Complications After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy.
- Author
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Baumgartner JM, Kwong TG, Ma GL, Messer K, Kelly KJ, and Lowy AM
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Chemotherapy, Adjuvant, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neoplasm Recurrence, Local pathology, Neoplasm Staging, Neoplasms therapy, Peritoneal Neoplasms therapy, Prognosis, Prospective Studies, Retrospective Studies, Severity of Illness Index, Survival Rate, Young Adult, Antineoplastic Combined Chemotherapy Protocols adverse effects, Chemotherapy, Cancer, Regional Perfusion adverse effects, Cytoreduction Surgical Procedures adverse effects, Hyperthermia, Induced adverse effects, Neoplasm Recurrence, Local epidemiology, Neoplasms pathology, Peritoneal Neoplasms secondary, Postoperative Complications
- 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.
- Published
- 2016
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