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Indian Journal of Surgical Oncology

, Volume 10, Supplement 1, pp 71–79 | Cite as

Failure-to-Rescue Following Cytoreductive Surgery with or Without HIPEC is Determined by the Type of Complication—a Retrospective Study by INDEPSO

  • Snita Sinukumar
  • Sanket Mehta
  • Dileep Damodaran
  • Firoz Rajan
  • Shabber Zaveri
  • Mukurdipi Ray
  • Ninad Katdare
  • Kayomarz Sethna
  • Mahesh D. Patel
  • Praveen Kammer
  • Abraham Peedicayil
  • Aditi BhattEmail author
Original Article

Abstract

To determine factors influencing failure-to-rescue in patients with complications following cytoreductive surgery and HIPEC. A retrospective analysis of patients enrolled in the Indian HIPEC registry was performed. Complications were graded according to the CTCAE classification version 4.3. The 30- and 90-day morbidity were both recorded. Three hundred seventy-eight patients undergoing CRS with/without HIPEC for peritoneal metastases from various primary sites, between January 2013 and December 2017 were included. The median PCI was 11 [range 0–39] and a CC-0/1 resection was achieved in 353 (93.5%). Grade 3–4 morbidity was seen 95 (25.1%) at 30 days and 122 (32.5%) at 90 days. The most common complications were pulmonary complications (6.8%), neutropenia (3.7%), systemic sepsis (3.4%), anastomotic leaks (1.5%), and spontaneous bowel perforations (1.3%). Twenty-five (6.6%) patients died within 90 days of surgery due to complications. The failure-to-rescue rate was 20.4%. Pulmonary complications (p = 0.03), systemic sepsis (p < 0.001), spontaneous bowel perforations (p < 0.001) and PCI > 20 (p = 0.002) increased the risk of failure-to-rescue. The independent predictors were spontaneous bowel perforation (p = 0.05) and systemic sepsis (p = 0.001) and PCI > 20 (p = 0.02). The primary tumor site did not have an impact on the FTR rate (p = 0.09) or on the grade 3–4 morbidity (p = 0.08). Nearly one-fifth of the patients who developed complications succumbed to them. Systemic sepsis, spontaneous bowel perforations, and pulmonary complications increased the risk of FTR and multidisciplinary teams should develop protocols to prevent, identify, and effectively treat such complications. All surgeons pursuing this specialty should perform a regular audit of their results, irrespective of their experience.

Keywords

Failure-to-rescue Hyperthermic intraperitoneal chemotherapy Peritoneal metastases Cytoreductive surgery 

Notes

Acknowledgments

The authors thank Professor Ramakrishnan Seshadri for giving his views on the subject and suggestions on this manuscript.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Supplementary material

13193_2019_877_MOESM1_ESM.docx (63 kb)
ESM 1 (DOCX 63 kb)

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Copyright information

© Indian Association of Surgical Oncology 2019

Authors and Affiliations

  • Snita Sinukumar
    • 1
  • Sanket Mehta
    • 2
  • Dileep Damodaran
    • 3
  • Firoz Rajan
    • 4
  • Shabber Zaveri
    • 5
  • Mukurdipi Ray
    • 6
  • Ninad Katdare
    • 7
  • Kayomarz Sethna
    • 8
  • Mahesh D. Patel
    • 9
  • Praveen Kammer
    • 2
  • Abraham Peedicayil
    • 10
  • Aditi Bhatt
    • 9
    Email author
  1. 1.Department of Surgical OncologyJehangir HospitalPuneIndia
  2. 2.Department of Peritoneal surface oncologySaifee HospitalMumbaiIndia
  3. 3.Department of surgical oncologyMVR Cancer Center and Research InstituteCalicutIndia
  4. 4.Department of surgical oncologyKovai Medical CenterCoimbatoreIndia
  5. 5.Department of surgical oncologyManipal HospitalBangaloreIndia
  6. 6.Department of surgical oncologyAll India Institute of Medical SciencesNew DelhiIndia
  7. 7.Department of surgical oncologyRaheja HospitalMumbaiIndia
  8. 8.Department of general surgeryLokmanya Tilak Municipal Medical College and HospitalMumbaiIndia
  9. 9.Department of Surgical OncologyZydus HospitalAhmedabadIndia
  10. 10.Department of Gynecologic oncologyChristian Medical College and HospitalVelloreIndia

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