title: Surgical outcomes of hyperthermic intraperitoneal chemotherapy: analysis of the american college of surgeons national surgical quality improvement program.
abstract: OBJECTIVE
  Hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery have been shown to benefit selected patients with peritoneal carcinomatosis. However, these procedures are associated with high morbidity and mortality. Available data investigating the outcomes of HIPEC are mostly limited to single-center studies. To date, there have been few large-scale studies investigating the postoperative outcomes of HIPEC.
  
  
  OBJECTIVE
  To determine the associated 30-day morbidity and mortality of cytoreductive surgery-HIPEC in the treatment of metastatic and primary peritoneal cancer in American College of Surgeons National Surgical Quality Improvement Program centers.
  
  
  METHODS
  A retrospective review of HIPEC cases performed for primary and metastatic peritoneal cancer diagnoses was conducted. The cytoreductive surgical procedures were sampled, and disease processes were identified. Patient demographics, intraoperative occurrences, and postoperative complications were reviewed from the American College of Surgeons National Surgical Quality Improvement Program from 2005-2011.
  
  
  METHODS
  Thirty-day mortality and morbidity.
  
  
  RESULTS
  Of the cancers identified among the 694 sampled cases, 14% of patients had appendiceal cancer, 11% had primary peritoneal cancer, and 8% had colorectal cancer. The American Society of Anesthesiologists classification was 3 for 70% of patients. The average operative time was 7.6 hours, with 15% of patients requiring intraoperative transfusions. Postoperative bleeding (17%), septic shock (16%), pulmonary complications (15%), and organ-space infections (9%) were the most prevalent postoperative complications. The average length of stay was 13 days, with a 30-day readmission rate of 11%. The rate of reoperation was 10%, with an overall mortality rate of 2%.
  
  
  CONCLUSIONS
  American College of Surgeons National Surgical Quality Improvement Program hospitals performing HIPEC have acceptable rates of morbidity and mortality.
authors.affiliation: Department of Surgery, University of California, Irvine, School of Medicine, Orange.
authors.forename: Mehraneh D
authors.initials: MD
authors.lastname: Jafari
authors.affiliation: Department of Surgery, University of California, Irvine, School of Medicine, Orange.
authors.forename: Wissam J
authors.initials: WJ
authors.lastname: Halabi
authors.affiliation: Department of Surgery, University of California, Irvine, School of Medicine, Orange.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stamos
authors.affiliation: Department of Statistics, University of California, Irvine.
authors.forename: Vinh Q
authors.initials: VQ
authors.lastname: Nguyen
authors.affiliation: Department of Surgery, University of California, Irvine, School of Medicine, Orange.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Carmichael
authors.affiliation: Department of Surgery, University of California, Irvine, School of Medicine, Orange.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Mills
authors.affiliation: Department of Surgery, University of California, Irvine, School of Medicine, Orange.
authors.forename: Alessio
authors.initials: A
authors.lastname: Pigazzi
mesh_terms: D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods; D013505:Digestive System Surgical Procedures / Q000379:methods / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000628:therapy*; D058996:Quality Improvement; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology