Advertisement

Annals of Surgical Oncology

, Volume 23, Issue 1, pp 99–105 | Cite as

Treatment-Related Mortality After Cytoreductive Surgery and HIPEC in Patients with Colorectal Peritoneal Carcinomatosis is Underestimated by Conventional Parameters

  • Geert A. Simkens
  • Thijs R. van Oudheusden
  • Hidde J. Braam
  • Misha D. Luyer
  • Marinus J. Wiezer
  • Bert van Ramshorst
  • Simon W. Nienhuijs
  • Ignace H. de Hingh
Colorectal Cancer

Abstract

Background

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) as treatment for patients with colorectal peritoneal carcinomatosis (PC) is regarded as an extensive procedure. The risk of postoperative mortality after major abdominal surgery might be substantially higher than described by the 30-day mortality. This study aims to identify causes of 1-year mortality, thereby assessing a more accurate treatment-related mortality rate after CRS + HIPEC.

Methods

All subsequent patients with colorectal PC treated with CRS + HIPEC with complete macroscopic cytoreduction in two tertiary hospitals between April 2005 and April 2013 were included in this study. Causes of 1-year mortality were carefully analyzed and patient data were compared between patients who died or did not die within 12 months after CRS + HIPEC.

Results

Of the 245 included patients, 34 (13.9 %) died within 12 months after CRS + HIPEC. The overall treatment-related mortality rate was 4.9 % (n = 12), and the 30-day and in-hospital mortality rates were 1.6 % (n = 4) and 2.4 % (n = 6), respectively. Furthermore, 18 patients (7.3 %) died due to early recurrent disease. Three patients (1.2 %) died of cardiovascular events, unrelated to CRS + HIPEC. The 1-year mortality group had more extensive peritoneal disease (p = 0.02) and the operative time in this group was longer (p < 0.001).

Conclusions

Overall treatment-related mortality was considerably higher than described by the 30-day and in-hospital mortality rate. However, even though complete macroscopic cytoreduction was achieved in every patient, the main cause of 1-year mortality was early recurrent disease. Both findings are valuable in preoperative patient selection, as well as in preoperative counseling of patients undergoing a CRS + HIPEC procedure.

Keywords

Peritoneal Carcinomatosis Peritoneal Cancer Index Glasgow Prognostic Score Hyperthermic Intraperitoneal Chemotherapy Peritoneal Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Disclosure

Geert A. Simkens, Thijs R. van Oudheusden, Hidde J. Braam, Misha D. Luyer, Marinus J. Wiezer, Bert van Ramshorst, Simon W. Nienhuijs, and Ignace H. de Hingh have no disclosures to report.

References

  1. 1.
    Cao C, Yan TD, Black D, Morris DL. A systematic review and meta-analysis of cytoreductive surgery with perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis of colorectal origin. Ann Surg Oncol. 2009;16(8):2152–2165.PubMedCrossRefGoogle Scholar
  2. 2.
    Kuijpers AM, Mirck B, Aalbers AG, et al. Cytoreduction and HIPEC in the Netherlands: nationwide long-term outcome following the Dutch protocol. Ann Surg Oncol. 2013;20(13):4224–4230.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Chua TC, Yan TD, Saxena A, Morris DL. Should the treatment of peritoneal carcinomatosis by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy still be regarded as a highly morbid procedure? A systematic review of morbidity and mortality. Ann Surg. 2009;249(6):900–907.PubMedCrossRefGoogle Scholar
  4. 4.
    van Gestel YR, Lemmens VE, de Hingh IH, et al. Influence of comorbidity and age on 1-, 2-, and 3-month postoperative mortality rates in gastrointestinal cancer patients. Ann Surg Oncol. 2013;20(2):371–380.PubMedCrossRefGoogle Scholar
  5. 5.
    Visser BC, Keegan H, Martin M, Wren SM. Death after colectomy: it’s later than we think. Arch Surg. 2009;144(11):1021–1027.PubMedCrossRefGoogle Scholar
  6. 6.
    van Oudheusden TR, Braam HJ, Nienhuijs SW, et al. Cytoreduction and hyperthermic intraperitoneal chemotherapy: a feasible and effective option for colorectal cancer patients after emergency surgery in the presence of peritoneal carcinomatosis. Ann Surg Oncol. 2014;21(8):2621–2626.PubMedGoogle Scholar
  7. 7.
    Swellengrebel HA, Zoetmulder FA, Smeenk RM, Antonini N, Verwaal VJ. Quantitative intra-operative assessment of peritoneal carcinomatosis: a comparison of three prognostic tools. Eur J Surg Oncol. 2009;35(10):1078–1084.PubMedCrossRefGoogle Scholar
  8. 8.
    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;240(2):205–213.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Cavaliere F, De Simone M, Virzi S, et al. Prognostic factors and oncologic outcome in 146 patients with colorectal peritoneal carcinomatosis treated with cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy: Italian multicenter study S.I.T.I.L.O. Eur J Surg Oncol. 2011;37(2):148–154.PubMedCrossRefGoogle Scholar
  10. 10.
    Ceelen W, Van Nieuwenhove Y, Putte DV, Pattyn P. Neoadjuvant chemotherapy with bevacizumab may improve outcome after cytoreduction and hyperthermic intraperitoneal chemoperfusion (HIPEC) for colorectal carcinomatosis. Ann Surg Oncol. 2014;21(9):3023–3028.PubMedCrossRefGoogle Scholar
  11. 11.
    Glehen O, Kwiatkowski F, Sugarbaker PH, et al. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol. 2004;22(16):3284–3292.PubMedCrossRefGoogle Scholar
  12. 12.
    Kianmanesh R, Scaringi S, Sabate JM, et al. Iterative cytoreductive surgery associated with hyperthermic intraperitoneal chemotherapy for treatment of peritoneal carcinomatosis of colorectal origin with or without liver metastases. Ann Surg. 2007;245(4):597–603.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Smeenk RM, Verwaal VJ, Zoetmulder FA. Learning curve of combined modality treatment in peritoneal surface disease. Br J Surg. 2007;94(11):1408–1414.PubMedCrossRefGoogle Scholar
  14. 14.
    Tabrizian P, Shrager B, Jibara G, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis: outcomes from a single tertiary institution. J Gastrointest Surg. 2014;18(5):1024–1031.PubMedCrossRefGoogle Scholar
  15. 15.
    Birkmeyer JD, Siewers AE, Finlayson EV, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346(15):1128–1137.PubMedCrossRefGoogle Scholar
  16. 16.
    Gooiker GA, Dekker JW, Bastiaannet E, et al. Risk factors for excess mortality in the first year after curative surgery for colorectal cancer. Ann Surg Oncol. 2012;19(8):2428–2434.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Byrne BE, Mamidanna R, Vincent CA, Faiz O. Population-based cohort study comparing 30- and 90-day institutional mortality rates after colorectal surgery. Br J Surg. 2013;100(13):1810–1817.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Dekker JW, Gooiker GA, Bastiaannet E, et al. Cause of death the first year after curative colorectal cancer surgery; a prolonged impact of the surgery in elderly colorectal cancer patients. Eur J Surg Oncol. 2014;40(11):1481–1487.PubMedCrossRefGoogle Scholar
  19. 19.
    Mamidanna R, Almoudaris AM, Faiz O. Is 30-day mortality an appropriate measure of risk in elderly patients undergoing elective colorectal resection? Colorectal Dis. 2012;14(10):1175–1182.PubMedCrossRefGoogle Scholar
  20. 20.
    Mullen JT, Ribero D, Reddy SK, et al. Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy. J Am Coll Surg. 2007;204(5):854–862; discussion 862-854.PubMedCrossRefGoogle Scholar
  21. 21.
    Rouvelas I, Jia C, Viklund P, Lindblad M, Lagergren J. Surgeon volume and postoperative mortality after oesophagectomy for cancer. Eur J Surg Oncol. 2007;33(2):162–168.PubMedCrossRefGoogle Scholar
  22. 22.
    Elias D, Gilly F, Boutitie F, et al. Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: retrospective analysis of 523 patients from a multicentric French study. J Clin Oncol. 2010;28(1):63–68.PubMedCrossRefGoogle Scholar
  23. 23.
    da Silva RG, Sugarbaker PH. Analysis of prognostic factors in seventy patients having a complete cytoreduction plus perioperative intraperitoneal chemotherapy for carcinomatosis from colorectal cancer. J Am Coll Surg. 2006;203(6):878–886.PubMedCrossRefGoogle Scholar
  24. 24.
    Simkens GA, van Oudheusden TR, Luyer MD, et al. Serious postoperative complications affect early recurrence after cytoreductive surgery and HIPEC for colorectal peritoneal carcinomatosis. Ann Surg Oncol. 2014.Google Scholar
  25. 25.
    Glehen O, Gilly FN, Boutitie F, et al. Toward curative treatment of peritoneal carcinomatosis from nonovarian origin by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy: a multi-institutional study of 1,290 patients. Cancer. 2010;116(24):5608–5618.PubMedCrossRefGoogle Scholar
  26. 26.
    Braam HJ, van Oudheusden TR, de Hingh IH, et al. Patterns of recurrence following complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer. J Surg Oncol. 2014;109(8):841–847.PubMedCrossRefGoogle Scholar
  27. 27.
    Klaver YL, Simkens LH, Lemmens VE, et al. Outcomes of colorectal cancer patients with peritoneal carcinomatosis treated with chemotherapy with and without targeted therapy. Eur J Surg Oncol. 2012;38(7):617–623.PubMedCrossRefGoogle Scholar
  28. 28.
    Ishizuka M, Nagata H, Takagi K, Horie T, Kubota K. Inflammation-based prognostic score is a novel predictor of postoperative outcome in patients with colorectal cancer. Ann Surg. 2007;246(6):1047–1051.PubMedCrossRefGoogle Scholar
  29. 29.
    Bartlett EK, Meise C, Roses RE, Fraker DL, Kelz RR, Karakousis GC. Morbidity and mortality of cytoreduction with intraperitoneal chemotherapy: outcomes from the ACS NSQIP database. Ann Surg Oncol. 2014;21(5):1494–1500.PubMedCrossRefGoogle Scholar
  30. 30.
    van de Poll MC, Klaver YL, Lemmens VE, Leenders BJ, Nienhuijs SW, de Hingh IH. C-reactive protein concentration is associated with prognosis in patients suffering from peritoneal carcinomatosis of colorectal origin. Int J Colorectal Dis. 2011;26(8):1067–1073.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Geert A. Simkens
    • 1
  • Thijs R. van Oudheusden
    • 1
  • Hidde J. Braam
    • 2
  • Misha D. Luyer
    • 1
  • Marinus J. Wiezer
    • 2
  • Bert van Ramshorst
    • 2
  • Simon W. Nienhuijs
    • 1
  • Ignace H. de Hingh
    • 1
  1. 1.Department of Surgical OncologyCatharina HospitalEindhovenThe Netherlands
  2. 2.Department of SurgerySt. Antonius HospitalNieuwegeinThe Netherlands

Personalised recommendations