TY - JOUR
T1 - Trends in Outcomes After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy
AU - Gani, Faiz
AU - Conca-Cheng, Alison M.
AU - Nettles, Brenda
AU - Ahuja, Nita
AU - Johnston, Fabian M.
N1 - Funding Information:
Over time, we observed a variable trend in postoperative morbidity after CRS/HIPEC. Specifically, although the postoperative morbidity decreased in the initial years of our study, it increased in the middle years of the study only to decrease again in the more recent years of the study. Possible explanations for the variable observed postoperative morbidity over the study are likely multifactorial and may relate to patient- and provider-level factors. Specifically, these improved outcomes may represent improvements in operative techniques, more developed postoperative care pathways, and methods of anesthesia, which collectively likely represent a “learning curve” for the team associated with performing CRS/HIPEC. 23-25 To this end, in the present study, we observed a consistent decrease in the operative time among all patients undergoing surgery, with patients with longer operative times demonstrating greater odds for 30-d morbidity/mortality, suggesting that improved operative methods over time may have contributed to the improvements in postoperative morbidity. Of note, the association between increasing operative times and adverse postoperative outcomes may also suggest that longer operative times are consistent with patients with higher volume disease, earlier surgeon learning curve, or other clinical variables that were not captured by the current data set. Supporting this and consistent with our findings, a series of reports attributed observed variable trends in postoperative morbidity (35% in 1996 to 27% in 1999) to a learning curve for surgeons and surgical teams alike. 17,18,23 As the number of programs performing CRS/HIPEC continues to increase nationally, our data along with previous reports reiterate the importance of operative volume, surgical team experience, and acknowledging the overall learning curve associated with CRS/HIPEC. 17,18,23
Publisher Copyright:
© 2018
PY - 2019/2
Y1 - 2019/2
N2 - Background: Hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery (CRS) have been shown to improve clinical outcomes among select patients presenting with peritoneal carcinomatosis. The aim of the present study was to describe temporal trends in clinical outcomes among patients undergoing CRS/HIPEC. Materials and methods: Patients who underwent CRS/HIPEC were identified using the American College of Surgeons National Surgical Quality Improvement Program databases from 2005 to 2013. A multivariable logistic regression analysis was performed to identify risk factors associated with postoperative morbidity and mortality. Results: A total of 889 patients were identified who met the inclusion criteria. The most common primary tumor sites were the peritoneum (59.8%), followed by the appendix (13.7%) and colon (6.4%). The median operative time for all patients was 438 min (interquartile range: 328-550); postoperative morbidity was 41.3%, and 2.0% of patients died within 30 d of surgery. Over the time evaluated, a statistically significant decrease was observed in the median operative time (2005 versus 2013, 600 versus 403 min), postoperative morbidity (50.0% versus 36.1%), and length of stay (13.5 versus 8 d; all P < 0.05). On multivariable analysis, age > 65 y (odds ratio [OR] = 1.51; 95% confidence interval [CI]: 1.02-2.24; P = 0.037), a low preoperative hematocrit (OR = 1.66; 95% CI: 1.19-2.33; P = 0.003), and preoperative serum albumin < 3 g/dL (OR = 2.10; 95% CI: 1.13-3.90; P = 0.019) were independently associated with greater odds for developing a postoperative complication and/or postoperative death. Conclusions: Operative time, postoperative morbidity, and length of stay after CRS/HIPEC were observed to improve over the study period. Careful patient selection may result in favorable outcomes for select patients undergoing CRS/HIPEC.
AB - Background: Hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery (CRS) have been shown to improve clinical outcomes among select patients presenting with peritoneal carcinomatosis. The aim of the present study was to describe temporal trends in clinical outcomes among patients undergoing CRS/HIPEC. Materials and methods: Patients who underwent CRS/HIPEC were identified using the American College of Surgeons National Surgical Quality Improvement Program databases from 2005 to 2013. A multivariable logistic regression analysis was performed to identify risk factors associated with postoperative morbidity and mortality. Results: A total of 889 patients were identified who met the inclusion criteria. The most common primary tumor sites were the peritoneum (59.8%), followed by the appendix (13.7%) and colon (6.4%). The median operative time for all patients was 438 min (interquartile range: 328-550); postoperative morbidity was 41.3%, and 2.0% of patients died within 30 d of surgery. Over the time evaluated, a statistically significant decrease was observed in the median operative time (2005 versus 2013, 600 versus 403 min), postoperative morbidity (50.0% versus 36.1%), and length of stay (13.5 versus 8 d; all P < 0.05). On multivariable analysis, age > 65 y (odds ratio [OR] = 1.51; 95% confidence interval [CI]: 1.02-2.24; P = 0.037), a low preoperative hematocrit (OR = 1.66; 95% CI: 1.19-2.33; P = 0.003), and preoperative serum albumin < 3 g/dL (OR = 2.10; 95% CI: 1.13-3.90; P = 0.019) were independently associated with greater odds for developing a postoperative complication and/or postoperative death. Conclusions: Operative time, postoperative morbidity, and length of stay after CRS/HIPEC were observed to improve over the study period. Careful patient selection may result in favorable outcomes for select patients undergoing CRS/HIPEC.
KW - Cytoreductive surgery
KW - HIPEC
KW - Hyperthermic intraperitoneal chemotherapy
KW - Trends
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U2 - 10.1016/j.jss.2018.09.032
DO - 10.1016/j.jss.2018.09.032
M3 - Article
C2 - 30527480
AN - SCOPUS:85054850258
VL - 234
SP - 240
EP - 248
JO - Journal of Surgical Research
JF - Journal of Surgical Research
SN - 0022-4804
ER -