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Hepatic resection and blood transfusion increase morbidity after cytoreductive surgery and HIPEC for colorectal carcinomatosis

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Abstract

Background and objectives

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is an effective but complex treatment for peritoneal metastasis (PM). Our objective was to identify risk factors for postoperative morbidity and mortality following CRS-HIPEC.

Methods

Retrospective study of prospectively collected data of patients undergoing CRS-HIPEC for PM arises from colorectal cancer between January 2008 and December 2017. Perioperative variables were correlated with morbidity outcomes using a logistic regression model.

Results

Sixty-seven patients underwent CRS-HIPEC, and overall morbidity and mortality were 31.3% and 4.5% respectively. Major morbidity rate was 19.4%; 7.5% of patients were re-operated. Intraoperative blood transfusion (p = 0.01), liver resection (p < 0.01), and intestinal anastomosis (p < 0.01) were associated with a higher morbidity in univariate analysis. A multivariate analysis identified blood transfusion and liver resection as independent risk factors (OR 3.66, IC 1.13–16.54; OR 4.33, IC 1.17–11.46, respectively). Extension of visceral resection did not correlate with morbidity. Patients with lymph-node infiltration had a higher major complication rate (p = 0.01).

Conclusions

CRS-HIPEC is a feasible treatment for colorectal PM with an acceptable morbi-mortality rate in experienced centers. In our study, digestive anastomosis, perioperative blood transfusion, hepatic resection, and lymph-node infiltration were associated with higher morbidity rates.

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Acknowledgements

We would like to thank JM Morón and X Molina from the Hepatobiliary Unit for their valuable support and cooperation. Also, we would like to our team of surgical residents for their help and involvement.

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Authors and Affiliations

  1. Department of General and Digestive Surgery, Son Espases University Hospital, Carretera de Valldemossa, 79, 07120, Palma, Illes Balears, Spain

    C. Soldevila-Verdeguer, J. J. Segura-Sampedro, C. Pineño-Flores, X. González-Argente & R. Morales-Soriano

  2. Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain

    C. Soldevila-Verdeguer, J. J. Segura-Sampedro, C. Pineño-Flores, P. Sanchís-Cortés, X. González-Argente & R. Morales-Soriano

  3. School of Medicine, University of the Balearic Islands (UIB), Palma, Spain

    J. J. Segura-Sampedro & X. González-Argente

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  1. C. Soldevila-Verdeguer
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  2. J. J. Segura-Sampedro
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by CSV, JJSS, and CPF. The first draft of the manuscript was written by CSV and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to J. J. Segura-Sampedro.

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Authors have no financial conflicts of interest to disclose.

Ethical standards

Our study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

All the patients included in the study have signed an informed consent for the intervention, in which they have indicated their implicit consent for the collection of data for future oncological analyzes.

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Soldevila-Verdeguer, C., Segura-Sampedro, J.J., Pineño-Flores, C. et al. Hepatic resection and blood transfusion increase morbidity after cytoreductive surgery and HIPEC for colorectal carcinomatosis. Clin Transl Oncol 22, 2032–2039 (2020). https://doi.org/10.1007/s12094-020-02346-2

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  • DOI: https://doi.org/10.1007/s12094-020-02346-2

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