A novel preoperative risk score to optimize patient selection for performing concomitant liver resection with cytoreductive surgery/HIPEC
Year: 2020
Type: article
Study design: Observational Study
Abstract: 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.
Source: Journal of Surgical Oncology
DOI: 10.1002/jso.26239
Authors: Rachel M. Lee, Adriana C. Gamboa, Michael K. Turgeon, Mohammad Y. Zaidi, Charles Kimbrough, Jennifer Leiting, Travis Grotz, Andrew J. Lee, Keith Fournier, Benjamin Powers, Sean Dineen, Joel M. Baumgartner, Jula Veerapong, Harveshp Mogal, Callisia Clarke, Gregory Wilson, Sameer Patel, Ryan Hendrix, Laura Lambert, Courtney Pokrzywa, Daniel E. Abbott, Christopher J. LaRocca, Mustafa Raoof, Jonathan Greer, Fabian M. Johnston, Charles A. Staley, Jordan M. Cloyd, Shishir K. Maithel, Maria C. Russell
Institutions: University of Minnesota, Emory University, Winship Cancer Institute, Indiana University Indianapolis, The Ohio State University Wexner Medical Center, The Ohio State University, Mayo Clinic, University of Pittsburgh, University of Pittsburgh Medical Center, The University of Texas MD Anderson Cancer Center, University of South Florida, Moffitt Cancer Center, University of California San Diego, Medical College of Wisconsin, University of Cincinnati, University of Utah, Huntsman Cancer Institute, University of Massachusetts Chan Medical School, University of Wisconsin–Madison, Johns Hopkins University
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: G196810821, J. NRSA Training Core
OpenAlex ID: W3089447903