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A novel preoperative risk score to optimize patient selection for performing concomitant liver resection with cytoreductive surgery/HIPEC
Author(s) -
Lee Rachel M.,
Gamboa Adriana C.,
Turgeon Michael K.,
Zaidi Mohammad Y.,
Kimbrough Charles,
Leiting Jennifer,
Grotz Travis,
Lee Andrew J.,
Fournier Keith,
Powers Benjamin,
Dineen Sean,
Baumgartner Joel M.,
Veerapong Jula,
Mogal Harveshp,
Clarke Callisia,
Wilson Gregory,
Patel Sameer,
Hendrix Ryan,
Lambert Laura,
Pokrzywa Courtney,
Abbott Daniel E.,
LaRocca Christopher J.,
Raoof Mustafa,
Greer Jonathan,
Johnston Fabian M.,
Staley Charles A.,
Cloyd Jordan M.,
Maithel Shishir K.,
Russell Maria C.
Publication year - 2021
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.26239
Subject(s) - medicine , contraindication , hyperthermic intraperitoneal chemotherapy , cytoreductive surgery , concomitant , colorectal cancer , surgery , clinical endpoint , adenocarcinoma , gastroenterology , cancer , randomized controlled trial , alternative medicine , ovarian cancer , pathology
Background While parenchymal hepatic metastases were previously considered a contraindication to cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC), liver resection (LR) is increasingly performed with CRS/HIPEC. Methods Patients from the US HIPEC Collaborative (2000–2017) with invasive appendiceal or colorectal adenocarcinoma undergoing primary, curative intent CRS/HIPEC with CC0‐1 resection were included. LR was defined as a formal parenchymal resection. Primary endpoints were postoperative complications and overall survival (OS). Results A total of 658 patients were included. About 83 (15%) underwent LR of colorectal (58%) or invasive appendiceal (42%) metastases. LR patients had more complications (81% vs. 60%; p = .001), greater number of complications (2.3 vs. 1.5; p < .001) per patient and required more reoperations (22% vs. 11%; p = .007) and readmissions (39% vs. 25%; p = .014) than non‐LR patients. LR patients had decreased OS (2‐year OS 62% vs. 79%, p < .001), even when accounting for peritoneal carcinomatosis index and histology type. Preoperative factors associated with decreased OS on multivariable analysis in LR patients included age < 60 years (HR, 3.61; 95% CI, 1.10–11.81), colorectal histology (HR, 3.84; 95% CI, 1.69–12.65), and multiple liver tumors (HR, 3.45; 95% CI, 1.21–9.85) (all p < .05). When assigning one point for each factor, there was an incremental decrease in 2‐year survival as the risk score increased from 0 to 3 (0: 100%; 1: 91%; 2: 58%; 3: 0%). Conclusions As CRS/HIPEC + LR has become more common, we created a simple risk score to stratify patients considered for CRS/HIPEC + LR. These data aid in striking the balance between an increased perioperative complication profile with the potential for improvement in OS.