A multi-institutional analysis of Textbook Outcomes among patients undergoing cytoreductive surgery for peritoneal surface malignancies

Jason T. Wiseman, Sherif Abdel-Misih, Eliza W. Beal, Mohammad Y. Zaidi, Charles A. Staley, Travis Grotz, Jennifer Leiting, Keith Fournier, Andrew J. Lee, Sean Dineen, Benjamin Powers, Jula Veerapong, Joel M. Baumgartner, Callisia Clarke, Sameer H. Patel, Vikrom Dhar, Ryan J. Hendrix, Laura Lambert, Daniel E. Abbott, Courtney PokrzywaMustafa Raoof, Oliver Eng, Nadege Fackche, Jonathan Greer, Timothy M. Pawlik, Jordan M. Cloyd

Research output: Contribution to journalArticlepeer-review

Abstract

Background: While recent studies have introduced the composite measure of a textbook outcome (TO) for measuring postoperative outcomes, the incidence of a TO has not been characterized among patients undergoing cytoreductive surgery (CRS) for peritoneal surface malignancies (PSM). Study design: All patients who underwent CRS ± hyperthermic intraperitoneal chemotherapy (HIPEC) between 1999 and 2017 from 12 institutions were included. A TO was defined as the absence of any of the following criteria: completeness of cytoreduction >1, reoperation within 90-days, readmission within 90-days, mortality within 90-days, any grade ≥2 complication, hospital stay >75th percentile, and non-home discharge. Results: Among 1904 patients who underwent CRS, only 30.9% achieved a TO while 69.1% failed to achieve a TO most commonly because of postoperative complications. On multivariable analysis, factors associated with achieving a TO were age <65 years (OR: 1.5), albumin ≥3.5 g/dl (OR: 5.7), receipt of HIPEC (OR: 4.5), PCI ≤14 (OR: 2.2), intravenous fluid volume ≤10,000 ml (OR: 2.1), blood loss ≤1000 ml (OR: 4.2) and operative time <7 h (OR: 1.9); while receipt of neoadjuvant therapy (OR: 0.7) and liver resection (OR: 0.4) were associated with not achieving a TO (all p < 0.05). TO was associated with improved overall survival (median 159 months vs 56 months, p < 0.01) even after controlling for confounders on Cox regression (hazard ratio: 2.5, p < 0.01). Conclusion: Among patients undergoing CRS ± HIPEC for PSM, failure to achieve a TO is common and independently associated with worse overall survival.

Original languageEnglish (US)
Article number101492
JournalSurgical Oncology
Volume37
DOIs
StatePublished - Jun 2021

Keywords

  • Cytoreductive surgery
  • Heated intraperitoneal chemotherapy
  • Peritoneal malignancies
  • Textbook outcome

ASJC Scopus subject areas

  • Surgery
  • Oncology

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