Combined Protocol 30-day Risks ‘Acceptable’ For Peritoneal Carcinomatosis

Thirty-day outcomes indicate cytoreductive surgery and hyperthermic intraperitoneal chemotherapy may be feasible for patients with peritoneal carcinomatosis

medwireNews: US research suggests that cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) can be performed with acceptable levels of early morbidity and mortality.

Although the combined protocol may improve survival for patients with peritoneal carcinomatosis, the procedure has not been tested in prospective clinical trials against systemic treatment and its complexity has raised concerns about the associated risks, explain Alessio Pigazzi, from the University of California in Orange, USA, and co-authors.

Now data from 500 hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2011 reveal that just 2.3% of the 694 treated patients died within 30 days of treatment.

The overall 30-day rate of morbidity was 32.9% and 9.8% of patients had further surgery within 30 days of HIPEC.

“We used a large nationwide database to demonstrate that the overall mortality and morbidity rates associated with HIPEC-CRS are acceptable,” the researchers write in JAMA Surgery, noting that mortality is lower than previously reported in several large case series.
Most (67.4%) patients had unknown tumour pathology, while 10.4% were diagnosed with primary peritoneal cancer, 14.0% appendiceal cancer, and 8.0% colorectal cancer.

The majority (69.6%) of patients were American Society of Anesthesiologists class 3 status, denoting severe disturbances, while 23.9% were class 2 with mild disturbances, and 6.2% had life-threatening class 4 disturbances.

Postoperative bleeding occurred in 17.0% of patients, sepsis or septic shock in 15.9%, and pulmonary complications in 14.6%. In addition, 9% of patients developed organ-space infections, while 6% and 2% of the cohort experienced superficial and deep surgical site infections, respectively.

Patients stayed in hospital for an average of 13 days and 11.4% were readmitted within 30 days of discharge.

“Although the resultant morbidity is not negligible, with good patient selection, this modality appears to be overall safe and effective in experienced hands,” the team concludes.

Reference

Jafari M, Halabi W, Stamos MJ, et al. Surgical Outcomes of Hyperthermic Intraperitoneal Chemotherapy. Analysis of the American College of Surgeons National Surgical Quality Improvement Program. JAMA Surg; Advance online publication December 18, 2013. doi:10.1001/jamasurg.2013.3640.

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