Trends in the indications for and short-term outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy - 18/03/20

Doi : 10.1016/j.amjsurg.2019.09.017

Eliza W. Beal ^a, Ahmed Ahmed ^a, Travis Grotz ^b, Jennifer Leiting ^b, Keith F. Fournier ^c, Andrew J. Lee ^c, Sean Dineen ^d, Sophie Dessureault ^d, Joel M. Baumgartner ^e, Jula Veerapong ^e, Callisia Clarke ^f, Erin Strong ^f, Shishir K. Maithel ^g, Mohammad Y. Zaidi ^g, Sameer Patel ^h, Vikrom Dhar ^h, Ryan Hendrix ⁱ, Laura Lambert ⁱ, Fabian Johnston ^j, Nadege Fackche ^j, Mustafa Raoof ^k, Christopher LaRocca ^k, Sean Ronnekleiv-Kelly ^l, Courtney Pokrzywa ^l, Timothy M. Pawlik ^a, Sherif Abdel-Misih ^a, Jordan M. Cloyd ^a,^⁎
^a The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, USA
^b Mayo Clinic, Rochester, MN, USA
^c MD Anderson Cancer Center, Houston, TX, USA
^d Moffitt Cancer Center, Tampa, FL, USA
^e University of California San Diego, San Diego, CA, USA
^f Medical College of Wisconsin, Milkwaukee, WI, USA
^g Emory University, Atlanta, GA, USA
^h University of Cincinnati, Cincinnati, OH, USA
ⁱ University of Massachusetts Memorial Medical Center, Worcester, MA, USA
^j Johns Hopkins University, Baltimore, MD, USA
^k City of Hope, Duarte, CA, USA
^l University of Wisconsin, Madison, WI, USA

^∗Corresponding author. The Ohio State University Wexner Medical Center Department of Surgery, Division of Surgical Oncology, 410 W 10th Ave, N907 Doan Hall Columbus, OH, 43210, USA.The Ohio State University Wexner Medical Center Department of SurgeryDivision of Surgical Oncology410 W 10th AveN907 Doan Hall ColumbusOH43210USA

Abstract

Background

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is an increasingly utilized strategy for patients with peritoneal surface malignancies (PSM).

Methods

The US HIPEC Collaborative was retrospectively reviewed to compare the indications and perioperative outcomes of patients who underwent CRS ± HIPEC between 2000 and 2012 (P1) versus 2013–2017 (P2).

Results

Among 2,364 patients, 39% were from P1 and 61% from P2. The most common primary site was appendiceal (64%) while the median PCI was 13 and most patients had CCR 0 (60%) or 1 (25%). Over time, median estimated blood loss, need for transfusion, and length of hospital stay decreased. While the incidence of any (55% vs. 57%; p = 0.426) and Clavien III/IV complications did not change over time, there was a decrease in 90-day mortality (5% vs. 3%; p = 0.045).

Conclusion

CRS-HIPEC is increasingly performed for PSM at high-volume centers. Despite improvements in some perioperative outcomes and a reduction in postoperative mortality, morbidity rates remain high.

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Highlights

•	Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is an increasingly utilized strategy.
•	The current study examines indications and perioperative outcomes of patients undergoing CRS ± HIPEC over time.
•	Over time median estimated blood loss, need for transfusion, and length of hospital stay decreased.
•	While the incidence of any complication did not change over time, there was a decrease in 90-day mortality.
•	Despite improvements in some perioperative outcomes and a reduction in postoperative mortality, morbidity rates remain high.