Background and Objectives
Morbidity after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) for colorectal peritoneal carcinomatosis (PC) may negatively affect survival. The objective was to determine the impact of postoperative complications (CX) on survival in patients undergoing CRS + HIPEC for colorectal PC.
Methods
All patients undergoing laparotomy for planned CRS + HIPEC for colorectal PC at a single institution from 1999 to 2014 were included. Patients were divided into three groups: CRS + HIPEC without CX (+HIPEC−CX); CRS + HIPEC with postoperative complication (+HIPEC + CX); and aborted CRS and HIPEC due to unresectable disease (−HIPEC). Postoperative morbidity were defined as Clavien II+ complications. Kaplan‐Meier survival analyses and multivariable Cox proportional hazard modeling were used to describe the disease‐free (DFS) and overall survival (OS).
Results
One hundred and twenty‐two patients were included in the analysis (50 +HIPEC − CX, 40 +HIPEC + CX, 32‐HIPEC). Overall complication rate was 42%. OS at 1‐, 3‐, and 5‐years in patients undergoing successful CRS + HIPEC were 97%, 67%, and 45%. CX after successful CRS + HIPEC was independently associated with worsened OS (HR1.58, 95%CI, 1.19‐1.97) but not DFS (HR1.11, 95%CI, 0.56‐2.20). PCI also independently predicted worsened DFS (HR1.12, 95%CI, 1.06‐1.18) and OS (HR1.08, 95%CI, 1.04‐1.12). Patients with unresectable disease had significantly worse OS (HR6.50, 95%CI, 1.37‐7.01).
Conclusions
CX after CRS + HIPEC significantly affect OS. Patient selection and perioperative care are of paramount importance in the management of CRS + HIPEC for colorectal PC.