Utilization and Treatment Patterns of Cytoreduction Surgery and Intraperitoneal Chemotherapy in the United States

  • Ryan J. Ellis
  • Cary Jo R. Schlick
  • Anthony D. Yang
  • Emma L. Barber
  • Karl Y. Bilimoria
  • Ryan P. MerkowEmail author
Peritoneal Surface Malignancy



Cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) is an effective treatment option for selected patients with peritoneal metastases (PM), but national utilization patterns are poorly understood. The objectives of this study were to (1) describe population-based trends in national utilization of CRS/IPC; (2) define the most common indications for the procedure; and (3) characterize the types of hospitals performing the procedure.


The National Inpatient Sample (NIS) was used to identify patients from 2006 to 2015 who underwent CRS/IPC, and to calculate national estimates of procedural frequency and oncologic indication. Hospitals performing CRS/IPC were classified based on size and teaching status.


The estimated annual number of CRS/IPC cases increased significantly from 189 to 1540 (p < 0.001). Overall, appendiceal cancer was the most common indication (25.7%), followed by ovarian cancer (23.3%), colorectal cancer (22.5%), and unspecified PM (15.0%). Remaining cases (13.5%) were performed for other indications. Most cases were performed in large teaching hospitals (65.9%), compared with smaller teaching hospitals (25.1%), large non-teaching hospitals (5.3%), or small non-teaching hospitals (3.2%). Patients were more likely to undergo CRS/IPC without a diagnosis based on level I evidence (appendiceal, ovarian, or colorectal) at large non-academic hospitals (odds ratio 2.00, 95% confidence interval 1.18–3.38, p = 0.010) compared with large academic hospitals.


Utilization of CRS/IPC is increasing steadily in the US, is performed at many types of facilities, and often for a variety of indications that are not supported by high-level evidence. Given associated morbidity of CRS/IPC, a national registry dedicated to cases of IPC is necessary to further evaluate use and outcomes.



RJE (AHRQ 5T32HS000078) is supported by a postdoctoral research fellowship and the American College of Surgeons Clinical Scholars in Residence Program; ELB is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (K12 HD050121); and RPM is supported by the Agency for Research and Healthcare Quality (K12HS026385) and an Institutional Research Grant from the American Cancer Society (IRG-18-163-24).


Ryan J. Ellis, Cary Jo R. Schlick, Anthony D. Yang, Emma L. Barber, Karl Y. Bilimoria, and Ryan P. Merkow report no conflicts of interest, financial or otherwise, related to this work. As an organization, the American College of Surgeons had no role in the design and conduct of this study; analysis and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication. Views expressed in this work represent those of the authors only.


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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Ryan J. Ellis
    • 1
    • 2
    • 3
  • Cary Jo R. Schlick
    • 1
    • 2
  • Anthony D. Yang
    • 1
    • 2
  • Emma L. Barber
    • 1
    • 4
  • Karl Y. Bilimoria
    • 1
    • 2
    • 3
  • Ryan P. Merkow
    • 1
    • 2
    • 3
    Email author
  1. 1.Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  2. 2.Northwestern Institute for Comparative Effectiveness Research in Oncology, Robert H. Lurie Comprehensive Cancer CenterNorthwestern University Feinberg School of Medicine and Northwestern Memorial HospitalChicagoUSA
  3. 3.Division of Research and Optimal Patient CareAmerican College of SurgeonsChicagoUSA
  4. 4.Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Robert H. Lurie Comprehensive Cancer CenterNorthwestern University Feinberg School of Medicine and Northwestern Memorial HospitalChicagoUSA

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