title: Postoperative complications after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy affect long-term outcome of patients with peritoneal metastases from colorectal cancer: a two-center study of 101 patients.
abstract: BACKGROUND
  Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is an effective but potentially morbid treatment for colorectal cancer peritoneal metastases. The impact of treatment-related morbidity on long-term survival has been reported in various malignancies, but it has never been assessed in this clinical setting.
  
  
  OBJECTIVE
  The aim of this study was to assess the impact of major postoperative complications on oncological outcomes after cytoreduction and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases.
  
  
  METHODS
  Two prospective databases were reviewed. Major complications were defined as grade 3 to 5 according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. The extent of peritoneal involvement was scored by the use of the Peritoneal Cancer Index.
  
  
  METHODS
  This study was conducted in 2 high-volume peritoneal malignancy management centers.
  
  
  METHODS
  One hundred one consecutive patients with peritoneal metastases potentially amenable to macroscopically complete cytoreduction were selected.
  
  
  METHODS
  Peritonectomy procedures and multivisceral resections were used to remove all macroscopic tumor, and mitomycin-C plus cisplatin-based hyperthermic intraperitoneal chemotherapy was used to control microscopic residual disease.
  
  
  METHODS
  The primary outcomes measured were overall and disease-specific survival.
  
  
  RESULTS
  Mortality and major morbidity were 3.0%, and 23.8%. Median follow-up was 44.9 months (95% CI, 24.1-65.7). Five-year disease-specific survival was 14.3% for patients who experienced major complications and 52.3% for those who did not (p = 0.001). Five-year overall survival was 11.7% for patients who experienced major complications, and 58.8% for those who did not (p = 0.003). At multivariate analysis, major morbidity correlated to both worse overall and disease-specific survival, along with a Peritoneal Cancer Index >19, and suboptimal cytoreduction. Poor performance status correlated only to worse disease-specific survival, and liver metastases correlated to worse overall survival. Longer operative time (OR, 4.1; 95% CI, 1.3-12.6; p = 0.01) and Peritoneal Cancer Index >19 (OR, 2.6; 95% CI, 1.1-6.0; p = 0.02) were independent risk factors for major morbidity.
  
  
  CONCLUSIONS
  This study is limited by its observational design.
  
  
  CONCLUSIONS
  The prevention of major complications, by refining surgical technique and patient selection, is crucial because it affects oncologic outcome.
authors.affiliation: 1Peritoneal Surface Malignancy Program,Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy 2General Surgery Unit, Bentivoglio Hospital, Bentivoglio (BO), Italy 3Colorectal Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Baratti
authors.forename: S
authors.initials: S
authors.lastname: Kusamura
authors.forename: D
authors.initials: D
authors.lastname: Iusco
authors.forename: S
authors.initials: S
authors.lastname: Bonomi
authors.forename: A
authors.initials: A
authors.lastname: Grassi
authors.forename: S
authors.initials: S
authors.lastname: Virzì
authors.forename: E
authors.initials: E
authors.lastname: Leo
authors.forename: M
authors.initials: M
authors.lastname: Deraco
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D015179:Colorectal Neoplasms / Q000473:pathology*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D015999:Multivariate Analysis; D018579:Patient Selection; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D010537:Peritoneum / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D016685:Mitomycin; D002945:Cisplatin