Prognostic factors associated with severe complications after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Abstract

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) can significantly improve outcomes in certain peritoneal carcinomatosis patient groups but it is a complicated surgical procedure with high morbidity and mortality rates. Our study evaluated the preoperative and perioperative variables to understand whether any variable was associated with an increased risk of complications. We retrospectively evaluated thirty-three successive patients who underwent CRS and HIPEC between 2017 and 2020. Patients were assigned into Group 1 (15 patients) and Group 2 (18 patients) according to the severity of the complications. When the groups were compared in terms of age, gender, BMI, presence of the previous operation, presence of sarcopenia, primary malignancy, peritoneal cancer index, and cytoreduction completeness scores, no statistical differences were found. When the serum albumin levels in the preoperative and postoperative seventy-second hour were compared, both groups had a significant decrease (p=0.011 and p=0.001, respectively). When the decrease rate of serum albumin levels was compared, there was no significant difference (p=0.539). There was a statistically significant difference between the preoperative and postoperative seventy-second-hour haemoglobin levels in both groups (p=0.01 and p=0.00, respectively). When the groups were compared according to the decrease rate in haemoglobin levels fall was more pronounced in patients with more severe complications (p=0.036). We concluded that the decrease in albumin levels and haemoglobin levels in the perioperative period is important and that a significant decrease in haemoglobin levels in the first seventy-two hours may be a pioneering data in terms of the development of serious complications. Therefore, closer monitoring of those patients and being more proactive in their treatment can contribute to the prevention of serious complications that may develop.

Keywords

• Cytoreduction surgical procedures
• Hyperthermic intraperitoneal chemotherapy
• Prognosis
• Albumin
• Haemoglobin
• Postoperative complications

References

1. 1. Noiret B, Piessen G and Eveno C. Update of randomized controlled trials evaluating cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in prevention and therapy of peritoneal metastasis: a systematic review. Pleura and Peritoneum 2022; 7(2): 51–61.
2. 2. Wajekar AS, Solanki SL, Patil VP. Postoperative complications and critical care management after cytoreduction surgery and hyperthermic intraperitoneal chemotherapy: A systematic review of the literature. World J Crit Care Med. 2022 Nov 9;11(6):375-386. DOI: 10.5492/wjccm.v11.i6.375.
3. 3. Adam MA, Zhou H, Byrd J, Greenberg AL, Kelly YM, Hall L, et al. Predicting Severe Complications from Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy: A Data-Driven, Machine Learning Approach to Augment Clinical Judgment. Ann Surg Oncol. 2023 Sep;30(9):5433-5442. DOI: 10.1245/s10434-023-13657-3. Epub 2023 Jun 2.
4. 4. Tao J, JI P-T, Shen JJ, Lu Y. Survival and complications of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in elderly patients: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci. 2021 Sep;25(17):5330-5348. DOI: 10.26355/eurrev_202109_26640.
5. 5. Malfroy S, Wallet F, Maucort-Boulch D, Chardonnal L, Sens N, Friggeri A, et al. Complications after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for treatment of peritoneal carcinomatosis: Risk factors for ICU admission and morbidity prognostic score. Surg Oncol 2016; 25: 6-15 DOI:10.1016/j.suronc.2015.11.003]
6. 6. Baratti D, Kusamura S, Mingrone E, Balestra MR, Laterza B, Deraco M. Identification of a subgroup of patients at highest risk for complications after surgical cytoreduction and hyperthermic intraperitoneal chemotherapy. Ann Surg 2012; 256: 334-341 DOI: 10.1097/SLA.0b013e31825704e3
7. 7. Cardi M, Sibio S, Di Marzo F, Lefoche F, d'Agostino C, Fonsi GB, et al.
8. 8. Prognostic Factors Influencing Infectious Complications after Cytoreductive Surgery and HIPEC: Results from a Tertiary Referral Center. Gastroenterology Research and Practice 2019 May 2;2019:2824073. DOI: 10.1155/2019/2824073

9. 9. Wiseman JT, Abdel-Misih S, Beal EW, Zaidi MY, Staley CA, Grotz T, et al. A multi-institutional analysis of Textbook Outcomes among patients undergoing cytoreductive surgery for peritoneal surface malignancies. Surg Oncol 2021 Jun;37:101492. DOI: 10.1016/j.suronc.2020.11.006.
10. 10. Huang Y, Alzahrani NA, Chua TC, Huo YR, Liauw W, Morris DL. Impacts of Preoperative Serum Albumin Level on Outcomes of Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy. Ann Surg Oncol 2016; 23: 2411–2418 DOI: 10.1245/s10434-016-5172-9.
11. 11. Chen J, Li Y, Cui H. Preoperative low hematocrit is an adverse prognostic biomarker in ovarian cancer. Archives of Gynecology and Obstetrics 2021; 303: 767–775 DOI: 10.1007/s00404-020-05822-w.
12. 12. Dindo D, Demartines N, Clavien PA. Classification of Surgical Complications: A New Proposal With Evaluation in a Cohort of 6336 Patients and Results of a Survey. Ann Surg. 2004 Aug; 240(2): 205–213. DOI: 10.1097/01.sla.0000133083.54934.ae
13. 13. Hamaguchi Y, Kaido T, Okumura S, Kobayashi A, Hammad A, Tamai Y, et al.
14. 14. Proposal for new diagnostic criteria for low skeletal muscle mass based on computed tomography imaging in Asian adults. Nutrition. 2016; 32:1200–5. DOI: 10.1016/j.nut.2016.04.003
15. 15. Topgül K, Çetinkaya MB, Arslan NÇ, Gül MK, Çan M, Gürsel MF, et al.
16. 16. Peritoneal karsinomatoz tedavisinde sitoredüktif cerrahi (SRC) ve hipertermik intraperitoneal kemoterapi (HİPEK): Teknik detaylar ve başlangıç deneyimimiz. Ulus Cerrahi Derg 2015; 31:138-147. DOI: 10.5152/UCD.2015.2990
17. 17. Collins A, Spooner S, Horne J, Chainrai M, Runau F, Bourne T, et al.
18. 18. Perioperative Variables Associated With Prolonged Intensive Care Stay Following Cytoreductive Surgery for Ovarian Cancer. Anticancer Res 2021 Jun;41(6):3059-3065. DOI: 10.21873/anticanres.15089.
19. 19. Chok KS, Ng KK, Poon RT, Lo CM, Fan ST. Impact of postoperative complications on long-term outcome of curative resection for hepatocellular carcinoma. Br J Surg 2009 Jan;96(1):81-7. DOI: 10.1002/bjs.6358.
20. 20. Li QG, Li P, Tang D, Chen J, Wang D-R. Impact of postoperative complications on long-term survival after radical resection for gastric cancer. World J Gastroenterol. 2013; 19(25): 4060-4065 DOI: 10.3748/wjg.v19.i25.4060.