title: Treatment-Related Mortality After Cytoreductive Surgery and HIPEC in Patients with Colorectal Peritoneal Carcinomatosis is Underestimated by Conventional Parameters.
abstract: BACKGROUND
  Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) as treatment for patients with colorectal peritoneal carcinomatosis (PC) is regarded as an extensive procedure. The risk of postoperative mortality after major abdominal surgery might be substantially higher than described by the 30-day mortality. This study aims to identify causes of 1-year mortality, thereby assessing a more accurate treatment-related mortality rate after CRS + HIPEC.
  
  
  METHODS
  All subsequent patients with colorectal PC treated with CRS + HIPEC with complete macroscopic cytoreduction in two tertiary hospitals between April 2005 and April 2013 were included in this study. Causes of 1-year mortality were carefully analyzed and patient data were compared between patients who died or did not die within 12 months after CRS + HIPEC.
  
  
  RESULTS
  Of the 245 included patients, 34 (13.9 %) died within 12 months after CRS + HIPEC. The overall treatment-related mortality rate was 4.9 % (n = 12), and the 30-day and in-hospital mortality rates were 1.6 % (n = 4) and 2.4 % (n = 6), respectively. Furthermore, 18 patients (7.3 %) died due to early recurrent disease. Three patients (1.2 %) died of cardiovascular events, unrelated to CRS + HIPEC. The 1-year mortality group had more extensive peritoneal disease (p = 0.02) and the operative time in this group was longer (p < 0.001).
  
  
  CONCLUSIONS
  Overall treatment-related mortality was considerably higher than described by the 30-day and in-hospital mortality rate. However, even though complete macroscopic cytoreduction was achieved in every patient, the main cause of 1-year mortality was early recurrent disease. Both findings are valuable in preoperative patient selection, as well as in preoperative counseling of patients undergoing a CRS + HIPEC procedure.
authors.affiliation: Department of Surgical Oncology, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Geert A
authors.initials: GA
authors.lastname: Simkens
authors.affiliation: Department of Surgical Oncology, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Thijs R
authors.initials: TR
authors.lastname: van Oudheusden
authors.affiliation: Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Hidde J
authors.initials: HJ
authors.lastname: Braam
authors.affiliation: Department of Surgical Oncology, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Misha D
authors.initials: MD
authors.lastname: Luyer
authors.affiliation: Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Marinus J
authors.initials: MJ
authors.lastname: Wiezer
authors.affiliation: Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Bert
authors.initials: B
authors.lastname: van Ramshorst
authors.affiliation: Department of Surgical Oncology, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Simon W
authors.initials: SW
authors.lastname: Nienhuijs
authors.affiliation: Department of Surgical Oncology, Catharina Hospital, Eindhoven, The Netherlands. ignace.d.hingh@cze.nl.
authors.forename: Ignace H
authors.initials: IH
authors.lastname: de Hingh
mesh_terms: D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000009:adverse effects* / Q000401:mortality; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy / Q000009:adverse effects* / Q000401:mortality; D065426:Cytoreduction Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D011379:Prognosis; D015996:Survival Rate