Failure-to-Rescue Following Cytoreductive Surgery with or Without HIPEC is Determined by the Type of Complication—a Retrospective Study by INDEPSO
| Autor: | Dileep Damodaran, Praveen Kammer, Sanket Mehta, Mukurdipi Ray, Shabber Zaveri, Snita Sinukumar, Abraham Peedicayil, Aditi Bhatt, Firoz Rajan, Ninad Katdare, Mahesh D. Patel, Kayomarz Sethna |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
business.industry Retrospective cohort study Neutropenia medicine.disease Primary tumor Surgery 03 medical and health sciences 0302 clinical medicine Oncology Surgical oncology 030220 oncology & carcinogenesis Conventional PCI Medicine 030211 gastroenterology & hepatology Hyperthermic intraperitoneal chemotherapy Original Article business Cytoreductive surgery Complication |
| Popis: | To determine factors influencing failure-to-rescue in patients with complications following cytoreductive surgery and HIPEC. A retrospective analysis of patients enrolled in the Indian HIPEC registry was performed. Complications were graded according to the CTCAE classification version 4.3. The 30- and 90-day morbidity were both recorded. Three hundred seventy-eight patients undergoing CRS with/without HIPEC for peritoneal metastases from various primary sites, between January 2013 and December 2017 were included. The median PCI was 11 [range 0–39] and a CC-0/1 resection was achieved in 353 (93.5%). Grade 3–4 morbidity was seen 95 (25.1%) at 30 days and 122 (32.5%) at 90 days. The most common complications were pulmonary complications (6.8%), neutropenia (3.7%), systemic sepsis (3.4%), anastomotic leaks (1.5%), and spontaneous bowel perforations (1.3%). Twenty-five (6.6%) patients died within 90 days of surgery due to complications. The failure-to-rescue rate was 20.4%. Pulmonary complications (p = 0.03), systemic sepsis (p 20 (p = 0.002) increased the risk of failure-to-rescue. The independent predictors were spontaneous bowel perforation (p = 0.05) and systemic sepsis (p = 0.001) and PCI > 20 (p = 0.02). The primary tumor site did not have an impact on the FTR rate (p = 0.09) or on the grade 3–4 morbidity (p = 0.08). Nearly one-fifth of the patients who developed complications succumbed to them. Systemic sepsis, spontaneous bowel perforations, and pulmonary complications increased the risk of FTR and multidisciplinary teams should develop protocols to prevent, identify, and effectively treat such complications. All surgeons pursuing this specialty should perform a regular audit of their results, irrespective of their experience. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s13193-019-00877-x) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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