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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2010

01-05-2010 | Gastrointestinal Oncology

Critical Assessment of Risk Factors for Complications After Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei

Authors: Akshat Saxena, BMedSc, Tristan D. Yan, BSc (Med), MBBS, PhD, Terence C. Chua, BSc (Med) (Hons), MBBS, David L. Morris, MB, ChB, MD, PhD

Published in: Annals of Surgical Oncology | Issue 5/2010

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Abstract

Background

Cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) has demonstrated improved survival in selected patients with pseudomyxoma peritonei (PMP). However, this aggressive treatment modality has been consistently associated with variable rates of perioperative mortality between 0% and 18% and morbidity between 30% and 70%.
This study evaluates the clinical and treatment-related risk factors for perioperative morbidity and mortality in PMP patients who underwent CRS and PIC.

Materials and Methods

A total of 145 consecutive CRS and PIC procedures for PMP performed between January 1996 and March 2009 were evaluated. The association of 12 clinical and 20 treatment-related risk factors with grades III and IV/V morbidity were assessed by univariable and multivariable analysis.

Results

The mortality (grade V) rate was 3%. The morbidity rates of grades III and IV were 23% and 22%, respectively. Eight factors were associated with grade IV/V morbidity on univariable analysis: peritoneal cancer index ≥21 (P = .034), ASA score ≥3 (P = .003), operation duration ≥10 h (P < .001), left upper quadrant peritonectomy procedure (P = .037), colonic resection (P = .012), ostomy (P = .005), ileostomy (P = .012), and transfusion ≥6 units (p = 0.011). Multivariable analysis showed 2 significant risk factors for grade IV/V morbidity: ASA ≥ 3 (P = .006) and an operation length ≥10 h (P < .001).

Conclusions

CRS and PIC has an acceptable rate of perioperative mortality and morbidity in selected patients with PMP. Patients with bulky disease who undergo a long operation are at a particularly high risk of a severe adverse event.
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Metadata
Title
Critical Assessment of Risk Factors for Complications After Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei
Authors
Akshat Saxena, BMedSc
Tristan D. Yan, BSc (Med), MBBS, PhD
Terence C. Chua, BSc (Med) (Hons), MBBS
David L. Morris, MB, ChB, MD, PhD
Publication date
01-05-2010
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 5/2010
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-009-0875-9

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