Treatment-related post-operative mortality after cytoreductive surgery and perioperative intraperitoneal chemotherapy | Journal of Peritoneum (and other serosal surfaces)

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has an established role in selected patients for the treatment of peritoneal surface malignancy. However, CRS/HIPEC is associated with increased risk of morbidity and mortality. The aim of this review was to identify risk factors for post-operative mortality in an attempt to improve patient outcomes post CRS/HIPEC. This is a retrospective study of prospectively collected data on 1019 patients who underwent CRS/HIPEC by the same surgical team at St George Hospital, Kogarah, Australia, between January 1996 and July 2016. During the 20-year time-period seventeen patients (1.67%) died postoperatively. A higher peritoneal cancer index (PCI), completeness of cytoreduction (CC) score, longer operative time and a volume of intra-operative transfusion were evident in the hospital mortality group and were significantly associated with postoperative mortality on univariate analysis. Postoperative complications including infection, bleeding, pneumonia, fistula, collection and pancreatic leak were also associated with post-operative mortality. The most common cause of death was sepsis (n=15, 88.2%). It is difficult to determine pre-operative factors that can be utilized as predictors of post-operative mortality, as the overall incidence of in-hospital mortality post CRS/HIPEC was very low on our unit. Nevertheless, a cascade of events and learning curve was displayed