title: Critical assessment of risk factors for complications after cytoreductive surgery and perioperative intraperitoneal chemotherapy for pseudomyxoma peritonei.
abstract: BACKGROUND
  Cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) has demonstrated improved survival in selected patients with pseudomyxoma peritonei (PMP). However, this aggressive treatment modality has been consistently associated with variable rates of perioperative mortality between 0% and 18% and morbidity between 30% and 70%. This study evaluates the clinical and treatment-related risk factors for perioperative morbidity and mortality in PMP patients who underwent CRS and PIC.
  
  
  METHODS
  A total of 145 consecutive CRS and PIC procedures for PMP performed between January 1996 and March 2009 were evaluated. The association of 12 clinical and 20 treatment-related risk factors with grades III and IV/V morbidity were assessed by univariable and multivariable analysis.
  
  
  RESULTS
  The mortality (grade V) rate was 3%. The morbidity rates of grades III and IV were 23% and 22%, respectively. Eight factors were associated with grade IV/V morbidity on univariable analysis: peritoneal cancer index >or=21 (P = .034), ASA score >or=3 (P = .003), operation duration >or=10 h (P < .001), left upper quadrant peritonectomy procedure (P = .037), colonic resection (P = .012), ostomy (P = .005), ileostomy (P = .012), and transfusion >or=6 units (p = 0.011). Multivariable analysis showed 2 significant risk factors for grade IV/V morbidity: ASA >or= 3 (P = .006) and an operation length >or=10 h (P < .001).
  
  
  CONCLUSIONS
  CRS and PIC has an acceptable rate of perioperative mortality and morbidity in selected patients with PMP. Patients with bulky disease who undergo a long operation are at a particularly high risk of a severe adverse event.
authors.affiliation: Department of Surgery, St George Hospital, University of New South Wales, Sydney, Australia. a.saxena@ugrad.unimelb.edu.au
authors.forename: Akshat
authors.initials: A
authors.lastname: Saxena
authors.forename: Tristan D
authors.initials: TD
authors.lastname: Yan
authors.forename: Terence C
authors.initials: TC
authors.lastname: Chua
authors.forename: David L
authors.initials: DL
authors.lastname: Morris
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D010478:Chemotherapy, Cancer, Regional Perfusion; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D019990:Perioperative Care; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D011183:Postoperative Complications / Q000401:mortality* / Q000628:therapy; D011446:Prospective Studies; D011553:Pseudomyxoma Peritonei / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome