title: Intraperitoneal chemotherapy at the time of surgery is not associated with increased 30-day morbidity and mortality following colorectal resection.
abstract: BACKGROUND
  In the absence of large randomized trials, the independent contribution of intraperitoneal chemotherapy (IPC) to morbidity and mortality (M+M) from cytoreductive surgery remains uncertain. In a multi-institutional cohort of colorectal surgery patients, we examined the association between M+M and the use of IPC.
  
  
  METHODS
  Patients undergoing an open colorectal resection for cancer with and without administration of IPC were identified using the American College of Surgeons National Surgical Quality Improvement Program database (2005-2012). Multivariate logistic regression identified factors associated with 30-day M+M. Using a propensity score matching method, patients undergoing IPC were matched 1:3 to non-IPC patients. M+M within the matched cohort was compared using the χ (2) test.
  
  
  RESULTS
  Of the 33,912 patients identified, 188 had concurrent IPC. The M+M rates were 41 and 30 % with and without IPC, respectively (p = 0.002). In multivariate analysis, IPC was not associated with M+M (odds ratio 0.92; p = 0.62). Using a propensity score match to control for patient and operative factors, patients who received IPC (n = 188) were matched to patients who did not receive IPC (n = 365). The M+M rates in the matched cohort did not significantly differ (41 % with IPC and 45 % without IPC; p = 0.34). Similarly, mortality (1.1 vs. 2.5 %; p = 0.26) and length of stay (12 vs. 11 days; p = 0.27) were not affected by IPC status.
  
  
  CONCLUSIONS
  After controlling for patient and operative factors, IPC was not associated with increased M+M following colorectal resection. The high morbidity observed in patients receiving IPC appears to be driven by operative factors other than the use of IPC.
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA, Edmund.Bartlett@uphs.upenn.edu.
authors.forename: Edmund K
authors.initials: EK
authors.lastname: Bartlett
authors.forename: Rashikh A
authors.initials: RA
authors.lastname: Choudhury
authors.forename: Robert E
authors.initials: RE
authors.lastname: Roses
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Fraker
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Kelz
authors.forename: Giorgos C
authors.initials: GC
authors.lastname: Karakousis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010529:Peritoneal Cavity; D011183:Postoperative Complications; D011379:Prognosis; D057216:Propensity Score; D012307:Risk Factors; D015996:Survival Rate