Do certain surgical steps increase postoperative morbidity after cytoreductive surgery and HIPEC- a retrospective analysis |
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| Affiliation: | 1. Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany;2. National Center for Tumor Diseases (NCT/UCC), Dresden, Germany;3. German Cancer Research Center (DKFZ), Heidelberg, Germany;4. Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany;5. Department of Family Medicine, McGill University, Montréal, Canada;1. Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel;2. The Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel;1. Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, USA;2. Department of Orthopedic Surgery, Washington University, St. Louis, Missouri, USA;3. Department of Medicine, Washington University, St. Louis, Missouri, USA;4. McMaster University and Hamilton Health Sciences, Department of Surgery, Hamilton, Ontario, Canada;5. Division of Oncology, Washington University, St. Louis, Missouri, USA;6. Siteman Cancer Center, Barnes Jewish Hospital, and Washington University School of Medicine, USA;7. Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA, USA;1. Division of Surgical Oncology, The Hiram C. Polk, Jr., MD Department of Surgery, University of Louisville School of Medicine, Louisville, KY, 40292, USA;2. Department of Pathology, Norton Healthcare, Louisville, KY, 40292, USA;1. Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan;2. Department of Surgery, Hirakata Kohsai Hospital, 1-2-1 Fujisakahigashimachi, Hirakata, Osaka, 573-0153, Japan;1. Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of General and Visceral Surgery, Campus Benjamin Franklin, Berlin, Germany;2. Sorbonne Université, Department of Digestive Surgery, Assistance Publique des Hôpitaux de Paris AP-HP, Hôpital Saint Antoine, Paris, France;3. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA;4. Department of Gastroenterology, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France;5. Department of General, Visceral and Transplantation Surgery, Hospital of the University of Munich, Munich, Germany;6. Department of Gastroenterology and Inflammatory Bowel Disease Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea;7. Department of Surgery and Department of Internal Medicine and Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA;8. Sorbonne Université, Assistance Publique des Hôpitaux de Paris AP-HP, Department of Pathology, Saint-Antoine Hospital, Paris, France;9. Department of Surgery, University Hospital of Bonn, Bonn, Germany;10. Department of Surgery, University Medical Centre Mannheim and Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany;11. Department of Experimental and Clinical Medicine, IBD Unit, Careggi University Hospital, Florence, Italy;12. First Department of Propaedeutic Surgery, Hippokration General Hospital of Athens, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece;13. Department of General Surgery, Peking Union Medical College Hospital, Beijing, China;14. Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece;15. Department of Hepato-gastroenterology, CHU Tours, France;p. Department of Digestive, Oncological, Endocrine, Hepato-Biliary and Pancreatic Surgery, Liver Transplantation, Colorectal Surgery Unit, Trousseau Hospital, Tours, France;q. Clinical Research Center, Chiba University Hospital, Chiba, Japan;r. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA |
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| Abstract: | IntroductionIt has been shown that cytoreductive surgery (CRS) in combination with hyperthermic intraperitoneal chemotherapy (HIPEC) is an effective treatment for patients suffering from peritoneal malignancies. Despite good results, there is an ongoing debate about this treatment due to perioperative morbidity.The aim of this study is to identify relevant risk factors for an unfavorable postoperative outcome after CRS and HIPEC.Materials and methodsA retrospective analysis of a prospectively recorded database of all patients undergoing CRS and HIPEC between 2013 and 2020 in the Department of Surgery of the University Hospital Dresden was performed with a special focus on certain surgical steps of multivisceral resection, one- or 2- stage CRS/HIPEC and underlying diagnosis as possible risk factors for worse postoperative course.ResultsN = 173 CRS and HIPEC procedures were performed for various diagnoses. Relevant postoperative morbidity was 24% and 30d-mortality 1.2%. Simultaneous liver resections, preoperative hypalbuminemia and 2-staged CRS/HIPEC were significant risk factors for a worse postoperative course in multivariable analysis. Assessment of the association of simultaneous anastomoses and morbidity and mortality was inconclusive.ConclusionCRS and HIPEC is a safe treatment without relevant intraoperative morbidity and mortality and acceptable postoperative outcome. One-stage CRS/HIPEC should be preferred. |
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| Keywords: | Peritoneal malignancy Cytoreductive surgery HIPEC Risk factors Morbidity HIPEC" },{" #name" :" keyword" ," $" :{" id" :" pc_rQu5KAIlEs" }," $$" :[{" #name" :" text" ," _" :" hyperthermic intraperitoneal chemotherapy CRS" },{" #name" :" keyword" ," $" :{" id" :" pc_iMWU89OlLg" }," $$" :[{" #name" :" text" ," _" :" cytoreductive surgery PMP" },{" #name" :" keyword" ," $" :{" id" :" pc_hIhVIfowbq" }," $$" :[{" #name" :" text" ," _" :" pseudomyxoma peritonei |
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