TY - JOUR
T1 - Implications of Postoperative Complications for Survival After Cytoreductive Surgery and HIPEC
T2 - A Multi-Institutional Analysis of the US HIPEC Collaborative
AU - Gamboa, Adriana C.
AU - Lee, Rachel M.
AU - Turgeon, Michael K.
AU - Zaidi, Mohammad Y.
AU - Kimbrough, Charles W.
AU - Grotz, Travis E.
AU - Leiting, Jennifer
AU - Fournier, Keith
AU - Lee, Andrew J.
AU - Dineen, Sean P.
AU - Powers, Benjamin D.
AU - Veerapong, Jula
AU - Baumgartner, Joel M.
AU - Clarke, Callisia N.
AU - Mogal, Harveshp
AU - Patel, Sameer H.
AU - Lee, Tiffany C.
AU - Lambert, Laura A.
AU - Hendrix, Ryan J.
AU - Abbott, Daniel E.
AU - Pokrzywa, Courtney
AU - Raoof, Mustafa
AU - Eng, Oliver S.
AU - Johnston, Fabian M.
AU - Greer, Jonathan
AU - Cloyd, Jordan M.
AU - Maithel, Shishir K.
AU - Staley, Charles A.
N1 - Publisher Copyright:
© 2020, Society of Surgical Oncology.
PY - 2020/12
Y1 - 2020/12
N2 - Background: Postoperative complications (POCs) are associated with worse oncologic outcomes in various cancer histologies. The impact of POCs on the survival of patients with appendiceal or colorectal cancer after cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) is unknown. Methods: The US HIPEC Collaborative (2000–2017) was reviewed for patients who underwent CCR0/1 CRS/HIPEC for appendiceal/colorectal cancer. The analysis was stratified by noninvasive appendiceal neoplasm versus invasive appendiceal/colorectal adenocarcinoma. The POCs were grouped into infectious, cardiopulmonary, thromboembolic, and intestinal dysmotility. The primary outcomes were overall survival (OS) and recurrence-free survival (RFS). Results: Of the 1304 patients, 33% had noninvasive appendiceal neoplasm (n = 426), and 67% had invasive appendiceal/colorectal adenocarcinoma (n = 878). In the noninvasive appendiceal cohort, POCs were identified in 55% of the patients (n = 233). The 3-year OS and RFS did not differ between the patients who experienced a complication and those who did not (OS, 94% vs 94%, p = 0.26; RFS, 68% vs 60%, p = 0.15). In the invasive appendiceal/colorectal adenocarcinoma cohort, however, POCs (63%; n = 555) were associated with decreased 3-year OS (59% vs 74%; p < 0.001) and RFS (32% vs 42%; p < 0.001). Infectious POCs were the most common (35%; n = 196). In Multivariable analysis accounting for gender, peritoneal cancer index (PCI), and incomplete resection (CCR1), infectious POCs in particular were associated with decreased OS compared with no complication (hazard ratio [HR] 2.08; p < 0.01) or other types of complications (HR, 1.6; p < 0.01). Similarly, infectious POCs were independently associated with worse RFS (HR 1.61; p < 0.01). Conclusion: Postoperative complications are associated with decreased OS and RFS after CRS/HIPEC for invasive histology, but not for an indolent disease such as noninvasive appendiceal neoplasm, and this association is largely driven by infectious complications. The exact mechanism is unknown, but may be immunologic. Efforts must target best practices and standardized prevention strategies to minimize infectious postoperative complications.
AB - Background: Postoperative complications (POCs) are associated with worse oncologic outcomes in various cancer histologies. The impact of POCs on the survival of patients with appendiceal or colorectal cancer after cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) is unknown. Methods: The US HIPEC Collaborative (2000–2017) was reviewed for patients who underwent CCR0/1 CRS/HIPEC for appendiceal/colorectal cancer. The analysis was stratified by noninvasive appendiceal neoplasm versus invasive appendiceal/colorectal adenocarcinoma. The POCs were grouped into infectious, cardiopulmonary, thromboembolic, and intestinal dysmotility. The primary outcomes were overall survival (OS) and recurrence-free survival (RFS). Results: Of the 1304 patients, 33% had noninvasive appendiceal neoplasm (n = 426), and 67% had invasive appendiceal/colorectal adenocarcinoma (n = 878). In the noninvasive appendiceal cohort, POCs were identified in 55% of the patients (n = 233). The 3-year OS and RFS did not differ between the patients who experienced a complication and those who did not (OS, 94% vs 94%, p = 0.26; RFS, 68% vs 60%, p = 0.15). In the invasive appendiceal/colorectal adenocarcinoma cohort, however, POCs (63%; n = 555) were associated with decreased 3-year OS (59% vs 74%; p < 0.001) and RFS (32% vs 42%; p < 0.001). Infectious POCs were the most common (35%; n = 196). In Multivariable analysis accounting for gender, peritoneal cancer index (PCI), and incomplete resection (CCR1), infectious POCs in particular were associated with decreased OS compared with no complication (hazard ratio [HR] 2.08; p < 0.01) or other types of complications (HR, 1.6; p < 0.01). Similarly, infectious POCs were independently associated with worse RFS (HR 1.61; p < 0.01). Conclusion: Postoperative complications are associated with decreased OS and RFS after CRS/HIPEC for invasive histology, but not for an indolent disease such as noninvasive appendiceal neoplasm, and this association is largely driven by infectious complications. The exact mechanism is unknown, but may be immunologic. Efforts must target best practices and standardized prevention strategies to minimize infectious postoperative complications.
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U2 - 10.1245/s10434-020-08843-6
DO - 10.1245/s10434-020-08843-6
M3 - Article
C2 - 32696303
AN - SCOPUS:85088288936
SN - 1068-9265
VL - 27
SP - 4980
EP - 4995
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 13
ER -