Predicting Postoperative Morbidity Following Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy (CS+HIPEC) with Preoperative FACT-C (Functional Assessment of Cancer Therapy) and Patient-Rated Performance Status

Abstract

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CS+HIPEC) is associated with significant perioperative morbidity. One goal of our ongoing patient-reported health-related quality of life (HRQoL) program is to describe the prognostic value of HRQoL measures for predicting postoperative morbidity and mortality following CS+HIPEC. A retrospective analysis of a prospectively collected clinical database for all patients treated for peritoneal carcinomatosis and who participated in our patient-reported HRQoL program from 2001 to 2011 was done. Patients completed the Functional Assessment of Cancer Therapy questionnaire plus the colon symptom subscale, in addition to the Eastern Cooperative Oncology Group (ECOG) performance status rating prior to CS+HIPEC. The trial outcome index (TOI), a specific measure of function, symptoms, and physical well being of the patient, was analyzed. The TOI is a combination of the physical and functional well being subscales+the colon-specific subscale of the FACT-C. Of 855 patients, 387 (45.2%) participated in the HRQoL trials. Mean age was 53.3years, and 213 (55%) were female versus 174 (45%) males. There were 240 patients (62%) who had a complication versus 147 (38%) who had no complication. A 30-day mortality rate of 7.7% (30) was documented. Patients who suffered a 30-day postoperative mortality demonstrated a lower mean preoperative score in the FACT-C TOI 52.7 versus 61.7; P<0.001. Independent predictors of 30-day mortality on multivariate analysis included TOI (0.05), age (0.001), and smoking (0.001). Patients with a higher TOI score were less likely to suffer a mortality (95% CI 0.9-1.0, P=0.05). Patients with a higher emotional well being (EWB) score were less likely to suffer a complication 0.9 (95% CI 0.87-1.0, P=0.04). Other independent predictors of postoperative morbidity included diabetic status (P=0.05), ECOG performance status (0.001), and gender (0.02). Preoperative HRQoL, as measured by FACT-C and ECOG performance status and added to traditional factors, helps predict postoperative morbidity and mortality following CS+HIPEC.