Abstract
BackgroundCytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) is an effective treatment option for appropriately selected patients with peritoneal carcinomatosis. Our aim was to analyze a multidisciplinary approach and to study the perioperative risk factors associated with morbidity and mortality.MethodsWe reviewed all patients who underwent CRS + HIPEC from January 2019 till December 2020 at our oncologic center. Patient demographics, risk scores, intraoperative variables, postoperative care, analgesia protocol, and adverse events (AE) within 30 days after treatment were collected and statistically analyzed.ResultsOf the 98 patients evaluated preoperatively by a multidisciplinary team, 39 patients required active optimization. The median age was 61 years, and 67 were women. Most tumors were appendiceal in origin. The median peritoneal cancer index (PCI) score was 12, and the median operative time length (OTL) was 400 minutes. Body mass index, Physiological and Operative Severity Score for the enUmeration of morbidity, PCI score, crystalloid volume, cell concentrates, and OTL were associated with postoperative intensive care unit admission (p <0.05). Epidural analgesia was given to 74 patients. AEs occurred in 39 patients, and 25 of the AEs were classified as mild or moderate. The intraoperative variables associated with development of AEs were anesthesia technique, estimated blood loss, crystalloid volume, cell concentrates, OTL, and analgesia protocol (p <0.05). On multivariate analysis, crystalloid volume >6 L, intravenous sufentanil analgesic protocol, and OTL were associated with 67%, 38%, and 15% increased risk of AE, respectively.ConclusionOur study highlighted the importance of a perioperative protocol with a standardized multidisciplinary approach in order to decrease the incidence of postoperative AE.
Highlights
Peritoneal carcinomatosis used to be considered a palliative and incurable condition with poor survival rates [1] until 1995, when Sugarbaker et al standardized a surgical approach combined with locoregional chemotherapy, which enabled improvement in quality of life and survival [2]
Physiological and Operative Severity Score for the enUmeration of morbidity, peritoneal cancer index (PCI) score, crystalloid volume, cell concentrates, and operative time length (OTL) were associated with postoperative intensive care unit admission (p
The intraoperative variables associated with development of adverse events (AE) were anesthesia technique, estimated blood loss, crystalloid volume, cell concentrates, OTL, and analgesia protocol (p
Summary
Peritoneal carcinomatosis used to be considered a palliative and incurable condition with poor survival rates [1] until 1995, when Sugarbaker et al standardized a surgical approach combined with locoregional chemotherapy, which enabled improvement in quality of life and survival [2]. Cytoreductive surgery (CRS) combined with hyperthermic intraoperative chemotherapy (HIPEC) has evolved as an effective multimodal treatment for selected patients with peritoneal surface malignancies of different origins [3-7]. It requires a multidisciplinary and dedicated team and a standard perioperative approach, which includes appropriate patient selection, preoperative optimization, intraoperative protocol, and adequate postoperative care to improve outcomes [8,9]. How to cite this article Paulo J, Oliveira J, Silva M, et al (March 07, 2022) Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy: Analysis of Perioperative Risk Factors and Impact on Outcome. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) is an effective treatment option for appropriately selected patients with peritoneal carcinomatosis. Our aim was to analyze a multidisciplinary approach and to study the perioperative risk factors associated with morbidity and mortality
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