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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2018

01-03-2018 | Colorectal Cancer

The Comprehensive Complication Index: a New Measure of the Burden of Complications After Hyperthermic Intraperitoneal Chemotherapy

Authors: Sinziana Dumitra, MD, MSc, Michael O’Leary, MD, Mustafa Raoof, MD, Mark Wakabayashi, MD, Thanh H. Dellinger, MD, Ernest S. Han, MD, Stephen J. Lee, MD, Byrne Lee, MD

Published in: Annals of Surgical Oncology | Issue 3/2018

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ABSTRACT

Background

Cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) are complex surgeries with multiple comorbidities. The Clavien–Dindo classification (CDC) is the most commonly used method to report surgical morbidity, but limits it to the highest-grade complication. The Comprehensive Complication Index (CCI) is a score ranging from 0 to 100, calculated using all 30-day complications and their treatment after abdominal surgery. The aim of this study is to assess the CCI’s validity in the HIPEC patient population.

Methods

A review of our institutional cytoreduction database from 2009 to 2015 was undertaken. Patient demographics, pathology, Peritoneal Carcinomatosis Index (PCI), complications and their treatments, and length of stay (LOS) were reviewed. The CCI was calculated for each patient. Linear regression was used to assess whether the CCI and CDC were predictors of LOS.

Results

Of 157 patients reviewed, 110 (70.1%) underwent HIPEC. The majority were female (77, 66.9%), and the mean age was 53.7 years. Mean PCI was 13.2 [interquartile range (IQR) 7–18]. Median CDC was grade 2 (IQR 0–2), and only 9.8% had CDC of grade 4 or higher. Mean CCI was 21.4, while the median was 20.9 (IQR 0–30.8). Mean LOS was 16.2 days, while the median was 11 days (IQR 8–15 days). The CCI strongly correlated with LOS with coefficient of 0.46 [95% confidence interval (CI) 0.38–0.54, p = 0.000].

Conclusions

The CCI is an adequate tool to capture all complications and their overall burden in patients having undergone HIPEC. This study shows that the CCI can predict LOS and could be used to quantify and compare the burden of multiple complications.
Literature
1.
Chua TC, Yan TD, Saxena A, Morris DL. Should the treatment of peritoneal carcinomatosis by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy still be regarded as a highly morbid procedure? A systematic review of morbidity and mortality. Ann Surg. 2009; 249: 900–907.CrossRefPubMed
2.
Clavien PA, Barkun J, de Oliveira ML et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009; 250: 187–196.CrossRefPubMed
3.
Clavien PA, Strasberg SM. Severity grading of surgical complications. Ann Surg. 2009; 250: 197–198.CrossRefPubMed
4.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240: 205–213.CrossRefPubMedPubMedCentral
5.
Lehmann K, Eshmuminov D, Slankamenac K et al. Where oncologic and surgical complication scoring systems collide: time for a new consensus for CRS/HIPEC. World J Surg. 2016; 40: 1075–1081.CrossRefPubMed
6.
Winship C MR. Regression models with ordinal variables. Am Sociol Rev. 1984; 49: 13.CrossRef
7.
Slankamenac K, Graf R, Barkun J et al. The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg. 2013; 258: 1–7.CrossRefPubMed
8.
Slankamenac K, Nederlof N, Pessaux P et al. The comprehensive complication index: a novel and more sensitive endpoint for assessing outcome and reducing sample size in randomized controlled trials. Ann Surg. 2014; 260: 757–762; discussion 762–753.
9.
Slaman AE, Lagarde SM, Gisbertz SS, van Berge Henegouwen MI. A quantified scoring system for postoperative complication severity compared to the Clavien–Dindo classification. Dig Surg. 2015; 32: 361–366.CrossRefPubMed
10.
Nederlof N, Slaman AE, van Hagen P et al. Using the comprehensive complication index to assess the impact of neoadjuvant chemoradiotherapy on complication severity after esophagectomy for cancer. Ann Surg Oncol. 2016, 23(12):3964–3971.CrossRefPubMedPubMedCentral
11.
Marsman EM, de Rooij T, van Eijck CH et al. Pancreatoduodenectomy with colon resection for cancer: a nationwide retrospective analysis. Surgery. 2016; 160: 145–152.CrossRefPubMed
12.
Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res. 1996; 82: 359–374.CrossRefPubMed
13.
14.
15.
Burnham KP, Anderson DR. Multimodel inference: understanding AIC and BIC in model selection. Sociol Methods Res. 2004; 33: 261.CrossRef
16.
Jafari MD, Halabi WJ, Stamos MJ, et al. Surgical outcomes of hyperthermic intraperitoneal chemotherapy: analysis of the American College of Surgeons National Surgical Quality Improvement Program. JAMA Surg. 2014; 149: 170–175.CrossRefPubMed
17.
Elias D, Gilly F, Boutitie F, et al. Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: retrospective analysis of 523 patients from a multicentric French study. J Clin Oncol. 2010; 28: 63–68.CrossRefPubMed
18.
Elias D, Lefevre JH, Chevalier J, et al. Complete cytoreductive surgery plus intraperitoneal chemohyperthermia with oxaliplatin for peritoneal carcinomatosis of colorectal origin. J Clin Oncol. 2009; 27: 681–685.CrossRefPubMed
19.
Yan TD, Deraco M, Baratti D et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma: multi-institutional experience. J Clin Oncol. 2009; 27: 6237–6242.CrossRefPubMed
20.
21.
Trotti A, Colevas AD, Setser A et al. CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol. 2003; 13: 176–181.CrossRefPubMed
22.
Younan R, Kusamura S, Baratti D et al. Morbidity, toxicity, and mortality classification systems in the local regional treatment of peritoneal surface malignancy. J Surg Oncol 2008; 98: 253–257.CrossRefPubMed
23.
Basch E, Jia X, Heller G et al. Adverse symptom event reporting by patients vs clinicians: relationships with clinical outcomes. J Natl Cancer Inst. 2009; 101: 1624–1632.CrossRefPubMedPubMedCentral
24.
Chow A, Mayer EK, Darzi AW, Athanasiou T. Patient-reported outcome measures: the importance of patient satisfaction in surgery. Surgery 2009; 146: 435–443.CrossRefPubMed
25.
Strasberg SM, Hall BL. Postoperative morbidity index: a quantitative measure of severity of postoperative complications. J Am Coll Surg 2011; 213: 616–626.CrossRefPubMed
Metadata
Title
The Comprehensive Complication Index: a New Measure of the Burden of Complications After Hyperthermic Intraperitoneal Chemotherapy
Authors
Sinziana Dumitra, MD, MSc
Michael O’Leary, MD
Mustafa Raoof, MD
Mark Wakabayashi, MD
Thanh H. Dellinger, MD
Ernest S. Han, MD
Stephen J. Lee, MD
Byrne Lee, MD
Publication date
01-03-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 3/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-017-6157-z

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