Is routine admission to a critical care setting following hyperthermic intraperitoneal chemotherapy for ovarian cancer necessary?

Autor: van Stein RM; Dept. of Gynecologic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands., Aronson SL; Dept. of Gynecologic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands; Dept. of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands., Sikorska K; Dept. of Biometrics Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands., Hendriks FJ; Dept. of Gynecology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands., Hovinga EP; Dept. of Gynecologic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands., Houwink API; Dept. of Anesthesiology and Intensive Care, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands., Schutte PFE; Dept. of Anesthesiology and Intensive Care, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands., Schooneveldt MS; Dept. of Anesthesiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands., De Kroon CD; Dept. of Gynecology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands., Sonke GS; Dept. of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands., van Driel WJ; Dept. of Gynecologic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands. Electronic address: OVHIPEC@nki.nl.
Jazyk: angličtina
Zdroj: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2023 Dec; Vol. 49 (12), pp. 107084. Date of Electronic Publication: 2023 Oct 01.
DOI: 10.1016/j.ejso.2023.107084
Abstrakt: Introduction: Hyperthermic intraperitoneal chemotherapy (HIPEC) is increasingly being used in patients with stage III ovarian cancer undergoing interval cytoreductive surgery (CRS). It is uncertain whether routine postoperative admission to a critical care setting after CRS-HIPEC is necessary. This study aims to estimate the incidence of patients requiring critical care, and to create a prediction model to identify patients who may forego admission to a critical care setting.
Methods: We analyzed 154 patients with primary ovarian cancer undergoing interval CRS-HIPEC at two Dutch centers between 2007 and 2021. Patients were routinely admitted to a critical care setting for 12-24 h. Patients that received critical support as defined by pre-specified definitions were retrospectively identified. Logistic regression analysis with backward selection was used to predict the need for critical care and the model was validated using bootstrapping.
Results: Thirty-eight percent of patients received postoperative critical care, consisting mainly of hemodynamic interventions. Independent predictors of critical care were blood loss, norepinephrine dose during surgery, and age (bootstrapped AUC = 0.76). Using a probability cut-off of 20%, one-third of patients are defined as low-risk for requiring critical care, with a negative predictive value of 0.88.
Conclusions: The majority of patients,primarily undergoing low to intermediate complexity surgeries, did not receive critical care interventions after CRS-HIPEC. Selective admission to a critical care setting may be warranted and its feasibility and safety needs to be evaluated prospectively. Our prediction model can help identify patients in whom admission to a critical care setting may be omitted. Hospital costs and burden on critical care units will benefit from patient selection.
Competing Interests: Declaration of competing interest GS Sonke reports receiving institutional research support from Agendia, Biovica, AstraZeneca, Merck, Novartis, Roche and Seagen outside the scope of this study. The other authors have stated explicitly that there are no conflicts of interest in connection with this article.
(© 2023 Published by Elsevier Ltd.)
Databáze: MEDLINE
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