Citations 1
A novel preoperative risk score to optimize patient selection for performing concomitant liver resection with cytoreductive surgery/HIPEC
Lee, Rachel , Turgeon, Michael K. , Zaidi, Mohammad Y. , Kimbrough, Charles W. , Leiting, Jennifer L. , Grotz, Travis E. , Powers, Benjamin D. , Baumgartner, Joel , Veerapong, Jula , Hendrix, Ryan J. , Lambert, Laura , Pokrzywa, Courtney , Abbott, Daniel E. , LaRocca, Christopher J. , Raoof, Mustafa , Staley, Charles A., Cloyd, Jordan M. , Leiting, Jennifer L , Grotz, Travis E , Powers, Benjamin , Mogal, Harveshp , Clarke, Callisia N , Patel, Sameer H , Hendrix, Ryan J , Raoof, Mustafa , Gamboa, Adriana Carolina , Lee, Andrew , Fournier, Keith F. , Dineen, Seán , Clarke, Callisia N. , Wilson, Gregory C. , Greer, Jonathan B. , Johnston, Fabian M , Maithel, Shishir K , Russell, Maria Citarella
Journal of Surgical Oncology | October 1, 2020 | Volume: 123 | Issue: 1 | Pages: 187-195
AbstractBackgroundWhile 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.MethodsPatients 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).ResultsA 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%).ConclusionsAs 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.