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01-03-2016 | Colorectal Cancer

Predictors of Severe Morbidity After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Patients With Colorectal Peritoneal Carcinomatosis

Authors: Geert A. Simkens, MD, Thijs R. van Oudheusden, MD, Misha D. Luyer, MD, PhD, Simon W. Nienhuijs, MD, PhD, Grard A. Nieuwenhuijzen, MD, PhD, Harm J. Rutten, MD, PhD, FRCS, Ignace H. de Hingh, MD, PhD

Published in: Annals of Surgical Oncology | Issue 3/2016

Abstract

Background

Severe morbidity after cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) is, besides the obvious short-term consequences, associated with impaired long-term outcomes. The risk factors for severe morbidity in patients with peritoneal carcinomatosis (PC) of colorectal origin are poorly defined. This study aimed to identify risk factors for severe morbidity after CRS + HIPEC in patients with colorectal PC.

Methods

Patients with colorectal PC who underwent CRS + HIPEC between 2007 and 2015 were categorized and compared between those with and those without severe morbidity. Risk factors were identified using logistic regression analysis. Morbidity was graded according to the Clavien–Dindo classification, with grade 3 or higher indicating severe morbidity.

Results

This study included 211 patients, of whom 53 patients (25.1 %) experienced morbidity of grade 3 or higher. The identified risk factors for severe morbidity were extensive prior surgery [odds ratio (OR) 4.3], a positive recent smoking history (OR 4.0), a poor physical performance status (OR 2.9), and extensive cytoreduction (OR 1.2 per additional resection). Patients with a greater number of risk factors more often had severe morbidity and higher reoperation, readmission, and mortality rates. Furthermore, an internally validated preoperative prediction model for severe morbidity with an area under the curve of 70 % was constructed.

Conclusion

The current study identified risk factors for severe morbidity after CRS + HIPEC in patients with colorectal PC. Patients with a combination of risk factors have a substantial risk of severe morbidity and therefore should be carefully selected for CRS + HIPEC. The preoperative decision model can be a valuable additional tool in this process of patient selection.

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Title: Predictors of Severe Morbidity After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Patients With Colorectal Peritoneal Carcinomatosis
Authors: Geert A. Simkens, MD
Thijs R. van Oudheusden, MD
Misha D. Luyer, MD, PhD
Simon W. Nienhuijs, MD, PhD
Grard A. Nieuwenhuijzen, MD, PhD
Harm J. Rutten, MD, PhD, FRCS
Ignace H. de Hingh, MD, PhD
Publication date: 01-03-2016
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue 3/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-015-4892-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Predictors of Severe Morbidity After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Patients With Colorectal Peritoneal Carcinomatosis

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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