Predictors of morbidity and mortality in patients submitted to cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for ovarian carcinomatosis: a multicenter study

Macrì, Antonio; Accarpio, Fabio; Arcoraci, Vincenzo; Casella, Francesco; Cian, Franco De; Iaco, Pierandrea De; Orsenigo, Elena; Roviello, Franco; Scambia, Giovanni; Saladino, Edoardo; Galati, Marica

doi:10.1515/pp-2020-0139

Cited by 5 publications

(3 citation statements)

References 44 publications

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“…transfusion requirement as independent predictors of major complications following CRS/HIPEC. 18,19 Data previously published from Waikato Hospital found significantly fewer blood transfusions than another Australian cohort, likely due to surgical haemostasis and judicious blood product use. 17 The effect of operative duration on major complication rate likely reflects both technical proficiency and pre-operative case selection.…”

Section: Discussionmentioning

confidence: 94%

“…Operative duration was an independent risk factor for major complications. Previous studies have identified PCI, blood loss, and transfusion requirement as independent predictors of major complications following CRS/HIPEC 18,19 . Data previously published from Waikato Hospital found significantly fewer blood transfusions than another Australian cohort, likely due to surgical haemostasis and judicious blood product use 17 .…”

Section: Discussionmentioning

confidence: 97%

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Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in New Zealand: peri‐operative outcomes and service development over a decade

Lim,

Qin,

et al. 2024

ANZ Journal of Surgery

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BackgroundCytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is the standard of care for selected cases of peritoneal surface malignancy. However, due to its morbidity and learning curve, it is only delivered in six centres in Australia and Aotearoa New Zealand (AoNZ). In this study, we report peri‐operative morbidity and mortality following CRS/HIPEC at Waikato and Braemar Hospitals, which have treated patients from all regions of AoNZ since 2008.MethodsWe retrospectively reviewed a database of all patients undergoing CRS and HIPEC from 01/01/2008 to 01/11/2020 at Waikato and Braemar Hospitals.ResultsTwo‐hundred and forty procedures were performed for 221 patients with a mean age of 55, including 22 (9.2%) re‐do procedures. One hundred and eighty‐six cases were European, 32 were Māori, and 16 were Pasifika. There were 152 pseudomyxoma peritonei, 39 colorectal adenocarcinomas, 29 appendiceal cancers, 8 ovarian cancers, 6 peritoneal mesothelioma, and 6 other tumour types. The median PCI was 16. HIPEC was administered to 196 out of 196 CC0/1 cases (100%) and 3 out of 44 CC2/3 cases (6.8%). Fifty‐six cases (23.3%) had at least one major complication. There were two mortalities (0.8%) within 30 days. The median length of stay was 11 days. Operative duration was identified as an independent risk factor for major complications. There was considerable variation in the number of referrals from different regions of AoNZ. Over time, a decline in major complication rate is seen with increased case volume.ConclusionThe Waikato region has achieved favourable short‐term outcomes following CRS/HIPEC.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 97%

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in New Zealand: peri‐operative outcomes and service development over a decade

Lim,

Qin,

et al. 2024

ANZ Journal of Surgery

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“…Macrì et al recorded the ECOG score and severe morbidity as predictors of 60-days survival [ 152 , 153 ].…”

Section: Treatment Of Ovarian Cancer Metastatic Peritoneal Surface Ma...mentioning

confidence: 99%

Cytoreductive Surgery (CRS) and HIPEC for Advanced Ovarian Cancer with Peritoneal Metastases: Italian PSM Oncoteam Evidence and Study Purposes

Marrelli

Ansaloni²,

Federici

et al. 2022

Cancers

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Ovarian cancer is the eighth most common neoplasm in women with a high mortality rate mainly due to a marked propensity for peritoneal spread directly at diagnosis, as well as tumor recurrence after radical surgical treatment. Treatments for peritoneal metastases have to be designed from a patient’s perspective and focus on meaningful measures of benefit. Hyperthermic intraperitoneal chemotherapy (HIPEC), a strategy combining maximal cytoreductive surgery with regional chemotherapy, has been proposed to treat advanced ovarian cancer. Preliminary results to date have shown promising results, with improved survival outcomes and tumor regression. As knowledge about the disease process increases, practice guidelines will continue to evolve. In this review, we have reported a broad overview of advanced ovarian cancer management, and an update of the current evidence. The future perspectives of the Italian Society of Surgical Oncology (SICO) are discussed conclusively.

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The Association Between Perioperative Red Blood Cell Transfusions and 1-Year Mortality After Major Cancer Surgery: An International Multicenter Observational Study

Cata,

Guerra-Londono,

Ramirez

et al. 2024

Anesthesia &Amp; Analgesia

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BACKGROUND: Packed red blood cell (pRBC) transfusions in patients undergoing surgery for cancer are given to treat anemia or acute hemorrhage. Evidence indicates that pRBC transfusions are associated with poor perioperative and oncological outcomes. The ARCA-1 (Perioperative Care in the Cancer Patient-1) study was designed to test the association between perioperative pRBC transfusions and postoperative morbidity and mortality in patients undergoing cancer surgery. The primary hypothesis of our study was that perioperative pRBC transfusions have a negative impact on postoperative morbidity and 1-year mortality. METHODS: ARCA-1 was an international multicenter prospective observational cohort study. Participating centers enrolled a minimum of 30 consecutive adult patients with cancer who underwent surgery with curative intent. The primary end point was all-cause mortality 1 year after major cancer surgery. Secondary end points were rates of perioperative blood product use, 1-year cancer-specific mortality, overall survival, and 30-day morbidity and mortality. We performed a propensity score matching analysis to adjust for selection bias. A multivariable logistic regression model was fitted to estimate the effects of significant covariates on 1-year mortality, cancer-related mortality, and overall survival. RESULTS: A total of 1079 patients were included in the study. The rate of perioperative pRBC transfusions was 21.1%. Preoperative comorbidities, including anemia, American Society of Anesthesiologists (ASA) score of III to IV, a history of coronavirus disease 2019 (COVID-19), myocardial infarction, stroke, need for dialysis, history of blood transfusions, and metastatic disease were statistically significantly more frequent in transfused patients compared to nontransfused patients. The 1-year mortality rate was higher in transfused patients before (19.7% vs 6.5%; P < .0001) and after (17.4% vs 13.2%; P = .29) propensity score matching. 1-year mortality was 1.97 times higher in transfused than in no-transfused patients (odd ratio [OR], 1.97; 95% confidence interval [CI], 1.13–3.41). The odds of 1-year cancer mortality for patients who had perioperative pRBCs was 1.82 times higher (OR, 1.82; 95% CI, 0.97–3.43) compared to those who did not receive perioperative pRBC transfusion. The effect of perioperative pRBC transfusion on overall survival was also significant (hazard ratio [HR], 1.85; 95% CI, 1.15–2.99). Transfused patients also had a higher rate of 30-day postoperative mortality before (3.5% vs 0.7%; P = .0009) and after propensity score matching (4.2% vs 1.8%; P = .34). CONCLUSIONS: This international, multicenter observational study showed that perioperative pRBC transfusion was associated with an increased mortality risk.

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Predictors of morbidity and mortality in patients submitted to cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for ovarian carcinomatosis: a multicenter study

Cited by 5 publications

References 44 publications

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in New Zealand: peri‐operative outcomes and service development over a decade

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in New Zealand: peri‐operative outcomes and service development over a decade

Cytoreductive Surgery (CRS) and HIPEC for Advanced Ovarian Cancer with Peritoneal Metastases: Italian PSM Oncoteam Evidence and Study Purposes

The Association Between Perioperative Red Blood Cell Transfusions and 1-Year Mortality After Major Cancer Surgery: An International Multicenter Observational Study

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