A multi-institutional analysis of Textbook Outcomes among patients undergoing cytoreductive surgery for peritoneal surface malignancies.

Abstract

BACKGROUND:

While recent studies have introduced the composite measure of a textbook outcome (TO) for measuring postoperative outcomes, the incidence of a TO has not been characterized among patients undergoing cytoreductive surgery (CRS) for peritoneal surface malignancies (PSM).

STUDY DESIGN:

All patients who underwent CRS ± hyperthermic intraperitoneal chemotherapy (HIPEC) between 1999 and 2017 from 12 institutions were included. A TO was defined as the absence of any of the following criteria: completeness of cytoreduction >1, reoperation within 90-days, readmission within 90-days, mortality within 90-days, any grade ≥2 complication, hospital stay >75th percentile, and non-home discharge.

RESULTS:

Among 1904 patients who underwent CRS, only 30.9% achieved a TO while 69.1% failed to achieve a TO most commonly because of postoperative complications. On multivariable analysis, factors associated with achieving a TO were age <65 years (OR: 1.5), albumin ≥3.5 g/dl (OR: 5.7), receipt of HIPEC (OR: 4.5), PCI ≤14 (OR: 2.2), intravenous fluid volume ≤10,000 ml (OR: 2.1), blood loss ≤1000 ml (OR: 4.2) and operative time <7 h (OR: 1.9); while receipt of neoadjuvant therapy (OR: 0.7) and liver resection (OR: 0.4) were associated with not achieving a TO (all p < 0.05). TO was associated with improved overall survival (median 159 months vs 56 months, p < 0.01) even after controlling for confounders on Cox regression (hazard ratio: 2.5, p < 0.01).

CONCLUSION:

Among patients undergoing CRS ± HIPEC for PSM, failure to achieve a TO is common and independently associated with worse overall survival.

• Authors: Jason T Wiseman, Sherif Abdel-Misih, Eliza W Beal, Mohammad Y Zaidi, Charles A Staley, Travis Grotz, Jennifer Leiting, Keith Fournier, Andrew J Lee, Sean Dineen, Benjamin Powers, Jula Veerapong, Joel M Baumgartner, Callisia Clarke, Sameer H Patel, Vikrom Dhar, Ryan J Hendrix, Laura Lambert, Daniel E Abbott, Courtney Pokrzywa, Mustafa Raoof, Oliver Eng, Nadege Fackche, Jonathan Greer, Timothy M Pawlik, Jordan M Cloyd
• Journal: Surgical oncology (Surg Oncol) Vol. 37 Pg. 101492 (Jun 2021) ISSN: 1879-3320 [Electronic] Netherlands
• PMID: 33465587 (Publication Type: Journal Article)
• Copyright: Copyright © 2020. Published by Elsevier Ltd.

Topics

• Aged
• Cytoreduction Surgical Procedures (adverse effects, methods)
• Female
• Humans
• Male
• Middle Aged
• Peritoneal Neoplasms (surgery)
• Postoperative Complications (epidemiology)
• Retrospective Studies
• Risk Factors
• Survival Analysis
• Treatment Outcome
• United States (epidemiology)