Significance of diabetes on morbidity and mortality following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

Abstract

Background and Objectives Patients with diabetes suffering from peritoneal surface disease represent a challenge to treat due to the effects of both processes on multiple organ systems. We sought to define the impact of diabetes on outcomes following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). Methods A retrospective analysis of a prospective database of 1065 CRS/HIPEC procedures was conducted. Patient demographics, comorbidities, and tumor characteristics were reviewed. Results CRS/HIPEC was performed in 91 diabetic and 844 non-diabetic patients with peritoneal surface disease from 1991 to 2013. Diabetics and non-diabetics spent 6.8 and 3.1 (P = 0.009) days in the ICU, respectively. Diabetics were more likely to suffer major complications (P < 0.001) including infectious (P < 0.001) and thrombotic (P = 0.05) complications, arrhythmias (P = 0.007), renal insufficiency (P = 0.002) and respiratory failure (P = 0.002) than non-diabetics. Mortality was significantly worse for diabetic patients at 30-days (8.8% vs. 2.7%, P = 0.007) and at 90-days (13.2% vs. 5.2%, P = 0.008). Even after adjusting for other significant predictors of morbidity, diabetes predicted more major complications and increased mortality following CRS/HIPEC. Conclusions Diabetes predicts major complications and specific complication patterns associated with increased ICU stay and worse mortality in patients undergoing CRS/HIPEC. Diabetic patients deemed to be appropriate candidates for CRS/HIPEC should be treated with caution.

Postoperative complications affect long‐term outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal carcinomatosis

“…Higher PCI has been consistently reported as one of the main risk factors for increased perioperative complications by multiple studies . A variety of other risk factors have been described, including advanced age, hypoalbuminemia, diabetes, number of bowel resections and anastomoses, and low preoperative quality of life, but there is wide variability between studies based on patient selection, operative procedures, and hyperthermic intraperitoneal chemotherapy administration, making it difficult to compare results between studies. Proper selection is paramount in patients with high‐risk disease features or high PCI not only to minimize the risk of non‐therapeutic laparotomy, but also to identify patients that can tolerate the potential increased risk of perioperative complications that are expected for aggressive CRS.…”

Acute kidney injury increases the rate of major morbidities in cytoreductive surgery and HIPEC

“…We evaluated AKI in our cohort of patients using the KDIGO guidelines which have expanded on the RIFLE criteria to include serum creatinine increase as small as 0.3 mg/dL above baseline [ 20 ]. When we evaluate larger series of patients undergoing the HIPEC procedure, such terms nephrotoxicity , renal insufficiency , and renal failure are used to describe AKI and are reported in the range 1.3–18.6% [ [21] , [22] , [23] , [24] , [25] ]. In these series, the NCI-CTCAE criteria are often applied and only grade III-V toxicity often reported.…”

Cytoreduction with Hyperthermic Intraperitoneal Chemotherapy and Renal Insufficiency Related to Diabetes Mellitus: An Anesthetic Challenge

“…Severe renal insufficiency is considered a contraindication for this complex procedure [ 6 ]. Diabetes pre-disposes to significantly more major complications and increased mortality following CRS/HIPEC [ 2 ].…”

“…It is an extensive procedure with significant hemodynamic, metabolic, hematological unbalances predisposing to major complications. A recent manuscript highlighted that diabetes predicted significant more major complications and increased mortality following CRS/HIPEC [ 2 ]. Among them renal toxicity was reported to occur with a frequency ranged between 1.9-5.7%, depending on chemotherapy [ 3 , 4 , 5 ].…”