A novel preoperative risk score to optimize patient selection for performing concomitant liver resection with cytoreductive surgery/HIPEC.

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.

• 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
• Journal: Journal of surgical oncology (J Surg Oncol) Vol. 123 Issue 1 Pg. 187-195 (Jan 2021) ISSN: 1096-9098 [Electronic] United States
• PMID: 33002202 (Publication Type: Journal Article)
• Copyright: © 2020 Wiley Periodicals LLC.

Topics

• Appendiceal Neoplasms (pathology, therapy)
• Chemotherapy, Cancer, Regional Perfusion (mortality)
• Colorectal Neoplasms (pathology, therapy)
• Combined Modality Therapy
• Cytoreduction Surgical Procedures (mortality)
• Female
• Follow-Up Studies
• Hepatectomy (mortality)
• Humans
• Hyperthermia, Induced (mortality)
• Male
• Middle Aged
• Patient Selection
• Peritoneal Neoplasms (secondary, therapy)
• Preoperative Care
• Prognosis
• Risk Factors
• Survival Rate