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Annals of Surgical Oncology
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30-07-2022 | Cytostatic Therapy | Peritoneal Surface Malignancy

Postoperative Respiratory Failure Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy is Associated with Volume of Intraoperative Crystalloid Administration and Worse Survival

Authors: Eric Pletcher, MS, MD, Da Eun Cha, MD, Elizabeth Gleeson, MPH, MD, Tali Shaltiel, MD, Deepa Magge, MD, Umut Sarpel, MD, Noah Cohen, MD, Daniel Labow, MD, Benjamin Golas, MD

Published in: Annals of Surgical Oncology | Issue 1/2023

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Abstract

Background

Postoperative respiratory failure (PRF) is associated with increased morbidity after surgery. This retrospective study explores preoperative and perioperative risk factors associated with PRF in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) and the resultant impact on survival.

Methods

We identified all patients who underwent CRS/HIPEC at our institution between 2007 and 2017. PRF was defined as mechanical ventilation for more than 48 h after surgery or reintubation not related to an additional procedure within the first 30 days postoperatively. The relationship between clinicopathologic variables and PRF was examined using Kaplan–Meier log-rank survival analysis and multivariable Cox regression models with 90-day, 1-year and 5-year overall survival (OS).

Results

Overall, 314 patients underwent CRS/HIPEC, of whom 24 patients (7.6%) developed PRF. On univariable analysis, chronic obstructive pulmonary disease (COPD) was the only preoperative risk factor associated with PRF (p = 0.049). Of the intraoperative risk factors, diaphragmatic resection (p = 0.008), Peritoneal Cancer Index (PCI) > 20 (p < 0.001), and volume of intraoperative crystalloid (p < 0.001) were all associated with PRF. On multivariable Cox regression, only intraoperative crystalloid was significantly associated with PRF (p < 0.001), with a volume above 5.3 L (area under the curve [AUC] 0.77) having a high predictive accuracy for PRF. Five-year OS was significantly decreased in patients with PRF (30.2% vs. 52.6%, hazard ratio 2.6, 95% confidence interval 1.5–4.4; p < 0.001).

Conclusions

Liberal intraoperative crystalloid volume resuscitation is a potential independent, modifiable intraoperative risk factor for PRF following CRS/HIPEC that may contribute to decreased long-term OS.
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Metadata
Title
Postoperative Respiratory Failure Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy is Associated with Volume of Intraoperative Crystalloid Administration and Worse Survival
Authors
Eric Pletcher, MS, MD
Da Eun Cha, MD
Elizabeth Gleeson, MPH, MD
Tali Shaltiel, MD
Deepa Magge, MD
Umut Sarpel, MD
Noah Cohen, MD
Daniel Labow, MD
Benjamin Golas, MD
Publication date
30-07-2022
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 1/2023
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-022-12199-4

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