title: Where Oncologic and Surgical Complication Scoring Systems Collide: Time for a New Consensus for CRS/HIPEC.
abstract: BACKGROUND
  Morbidity and mortality rates after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are important quality parameters to compare peritoneal surface malignancy centers. A major problem to assess postoperative outcomes among centers is the inconsistent reporting due to two coexisting systems, the diagnose-based common terminology criteria for adverse events (CTCAE) classification and the therapy-oriented Clavien-Dindo classification. We therefore assessed and compared both reporting systems.
  
  
  METHODS
  Complications after CRS/HIPEC were recorded in 147 consecutive patients and independently graded by an expert board using both systems. In a next step, a group of residents, experienced surgeons, and medical oncologists evaluated a set of twelve real complications, either with the Clavien-Dindo or CTCAE classification.
  
  
  RESULTS
  The postoperative complication rate after CRS/HIPEC was 37 % (54/147), 6.8 % (10/147) were reoperated, and three (2 %) patients died. The most frequent complications were intestinal fistula or abscess, pulmonary complications, and ileus. Grading of complications with the CTCAE classification resulted in a significantly higher major morbidity rate compared to the Clavien-Dindo classification (25 vs. 8 %, p = 0.001). Evaluating a set of complications, residents, surgeons, and oncologists correctly assessed significantly more complications with the Clavien-Dindo compared to the CTCEA classification (p < 0.001). In addition, all participants evaluated the Clavien-Dindo classification as more simple. Residents (p < 0.001) and surgeons (p < 0.01) required less time with the Clavien-Dindo classification; there was no difference for oncologist.
  
  
  CONCLUSIONS
  In conclusion, our data indicate that there is a different interpretation of severity grades of complications after CRS/HIPEC between the two classifications. There is a need for a common language in the field of CRS/HIPEC, which should be defined by a new consensus to compare surgical outcomes.
authors.affiliation: Klinik für Viszeral- und Transplantationschirurgie, Universitätsspital Zürich, Rämistrasse 100, 8091, Zurich, Switzerland. lehmann.kuno@gmail.com.
authors.forename: Kuno
authors.initials: K
authors.lastname: Lehmann
authors.affiliation: Klinik für Viszeral- und Transplantationschirurgie, Universitätsspital Zürich, Rämistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Dilmurodjon
authors.initials: D
authors.lastname: Eshmuminov
authors.affiliation: Klinik für Viszeral- und Transplantationschirurgie, Universitätsspital Zürich, Rämistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Ksenija
authors.initials: K
authors.lastname: Slankamenac
authors.affiliation: Klinik für Viszeral- und Transplantationschirurgie, Universitätsspital Zürich, Rämistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Benedict
authors.initials: B
authors.lastname: Kranzbühler
authors.affiliation: Klinik für Viszeral- und Transplantationschirurgie, Universitätsspital Zürich, Rämistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Pierre-Alain
authors.initials: PA
authors.lastname: Clavien
authors.affiliation: Klinik für Viszeral- und Transplantationschirurgie, Universitätsspital Zürich, Rämistrasse 100, 8091, Zurich, Switzerland.
authors.forename: René
authors.initials: R
authors.lastname: Vonlanthen
authors.affiliation: Klinik für Viszeral- und Transplantationschirurgie, Universitätsspital Zürich, Rämistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Gertsch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000009:adverse effects*; D065426:Cytoreduction Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000145:classification*; D012720:Severity of Illness Index; D013557:Switzerland; D055815:Young Adult