Trends in Outcomes After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy

Faiz Gani, Alison M. Conca-Cheng, Brenda Nettles, Nita Ahuja, Fabian Johnston

Research output: Contribution to journalArticle

Abstract

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.

LanguageEnglish (US)
Pages240-248
Number of pages9
JournalJournal of Surgical Research
Volume234
DOIs
StatePublished - Feb 1 2019

Fingerprint

Drug Therapy
Operative Time
Morbidity
Odds Ratio
Confidence Intervals
Length of Stay
Peritoneum
Appendix
Quality Improvement
Hematocrit
Serum Albumin
Patient Selection
Colon
Logistic Models
Regression Analysis
Databases
Carcinoma
Mortality
Neoplasms

Keywords

  • Cytoreductive surgery
  • HIPEC
  • Hyperthermic intraperitoneal chemotherapy
  • Trends

ASJC Scopus subject areas

  • Surgery

Cite this

Trends in Outcomes After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy. / Gani, Faiz; Conca-Cheng, Alison M.; Nettles, Brenda; Ahuja, Nita; Johnston, Fabian.

In: Journal of Surgical Research, Vol. 234, 01.02.2019, p. 240-248.

Research output: Contribution to journalArticle

@article{bd74b6eda06f4170aa97451462afe963,
title = "Trends in Outcomes After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy",
abstract = "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.",
keywords = "Cytoreductive surgery, HIPEC, Hyperthermic intraperitoneal chemotherapy, Trends",
author = "Faiz Gani and Conca-Cheng, {Alison M.} and Brenda Nettles and Nita Ahuja and Fabian Johnston",
year = "2019",
month = "2",
day = "1",
doi = "10.1016/j.jss.2018.09.032",
language = "English (US)",
volume = "234",
pages = "240--248",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",

}

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

PY - 2019/2/1

Y1 - 2019/2/1

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

UR - http://www.scopus.com/inward/record.url?scp=85054850258&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85054850258&partnerID=8YFLogxK

U2 - 10.1016/j.jss.2018.09.032

DO - 10.1016/j.jss.2018.09.032

M3 - Article

VL - 234

SP - 240

EP - 248

JO - Journal of Surgical Research

T2 - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

ER -