The morbidity of cytoreduction/hyperthermic intraperitoneal chemoperfusion (HIPEC) in the modern era.

Abstract

e14172 Background: Critics of cytoreduction/HIPEC for treatment of peritoneal surface malignancies cite high morbidity/mortality in historical published literature. With improved patient selection algorithms based upon recent clinical experience, perioperative morbidity/mortality should be comparable to the treatment of other GI malignancies. Methods: Retrospective data collection on all patients undergoing cytoreduction/HIPEC at a single institution (2 surgeons) from 2003-2011. Patient demographics, perioperative complications, mortality, and survival were analyzed (logistic regression modeling, Kaplan Meier, and Log rank testing). Results: 113 patients (45M/68F; median age 53 years) underwent 124 cytoreduction/HIPEC procedures. Primary tumor histology was colorectal adenocarcinoma (34%), appendiceal DPAM (24%), appendical adenocarcinoma (21%), mesothelioma (10%), and other (11%). 46% of patients received systemic chemotherapy prior to cytoreduction/HIPEC. Median HIPEC time was 12 hours (range 6 to 20 hours). All patients received mitomycin C at first HIPEC with 26% receiving a dose reduction. Median number of GI anastomoses was 1 (range 0-3). Median ICU stay was 1 day (range 0-21) and median length of stay (LOS) was 12 days (range 6-122). Major postoperative complications included wound infection (15%), anastomotic leak (11%), neutropenia (7%), pulmonary (5%), and thromboembolic events (2%). The reoperation rate for complications was 15%. Operative mortality at 30 and 60 days was 0% and 3%, respectively. As a surrogate for complications, LOS >14 days occurred in 24% of patients. Median follow-up was 25 months (1-80 months). Median progression-free and overall survival were 26.3 and 68.5 months, respectively. An anastomotic leak was associated with increased LOS, decreased progression-free survival (15.3 months, p< 0.05) and overall survival (15.3 months, p< 0.005). Conclusions: Despite being stage IV disease, perioperative morbidity/mortality for cytoreduction/HIPEC is comparable to surgical treatment of primary upper GI malignancies. Patient selection and meticulous technique may be critical to avoid anastomotic leaks associated with decreased survival.