Predictors of morbidity and mortality for patients with peritoneal carcinomatosis secondary to colorectal cancer following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Abstract

Introduction: Even though cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has been associated with high morbidity and mortality rates, it has been reported that CRS and HIPEC improved survival of selected patients with peritoneal carcinomatosis. This study aimed to identify risk factors for severe morbidity and mortality after CRS + HIPEC in patients with peritoneal carcinomatosis secondary to colorectal cancer. Methods: Patients diagnosed with peritoneal carcinomatosis secondary to colorectal origin from March 2012 to December 2017 who underwent CRS + HIPEC were included in the study. All data prospectively entered in the HIPEC registry was analyzed with main focus on grade III–IV morbidity and mortality and factors predicting them. Risk factors were identified using logistic regression analysis. Results: The study included 163 cases of colorectal cancer with peritoneal metastasis; 20 were upfront, 94 interval, and 49 recurrent cases. Mean duration of surgery was 9.5 hours, blood loss 1250 mL and PCI 19. Total, upper quadrant, pelvic, paracolic peritonectomy, glissons capsulectomy, and mesenteric stripping was done in 42.5%, 68.1%, 69.3%, 72.5%, 14.7%, and 4.3%, respectively. Multivisceral resection, diaphragmatic resection, and bowel resection were done in 20.9%, 40.5%, and 57.5%, respectively. Based on Common Terminology Criteria for Adverse Events, the overall rate of morbidity grade III–IV was 18.4 %, the major being surgical 26%, hematological 20%, and electrolyte imbalance 19%. The 60-day mortality rate was 5%. Re-operation rate was 9%. Re-operation was needed in 11% and the mortality rate was 2.4%. In multivariate analysis the identified risk factors for severe morbidity were performance status, mean PCI >14, duration of surgery >10 hours, multivisceral resection, total peritonectomy, upper quadrant peritonectomy, more than one. Conclusion: On evaluating the perioperative outcomes following CRS + HIPEC for peritoneal carcinomatosis secondary to colorectal cancer, the impact on early mortality and morbidity was acceptable. The low mortality rate and 18.4 % grade III–IV morbidity of CRS and HIPEC when weighed against overall benefit is reasonable. Optimal patient selection, such as patients with PCI < 14 with good performance status, seems to be of paramount importance to CRS and HIPEC. This multimodal treatment appears feasible for selected patients and in trained HIPEC centers.