title: Complications after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for treatment of peritoneal carcinomatosis: Risk factors for ICU admission and morbidity prognostic score.
abstract: OBJECTIVE
  For patients suffering from peritoneal carcinomatosis, cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is the only curative option. We focused on severe complications in the postoperative course of HIPEC.
  
  
  METHODS
  We studied perioperative data from patients who underwent HIPEC between January 2010 and August 2011. Our primary objective was to identify perioperative risk factors for ICU admission. Our secondary objective was to identify patient that may be re-admitted to the ICU thanks to a prognostic score.
  
  
  RESULTS
  122 patients underwent HIPEC. 32 presented severe adverse events (26.2%) and 7 died (5.7%). Reasons for ICU admission were septic shock in 28.1% of patients, hemorrhagic shock for 21.9%, hemodynamic instability for 15.6%, respiratory causes for 6.2% and post-operative acidosis for 6.2%. Vasopressors were required for 34% and 40.6% were mechanically ventilated.
  
  
  CONCLUSIONS
  Peritoneal cancer index, diaphragmatic peritonectomy, the need of vasopressive therapy, total volume of fluid leakage collected in drains and total volume of fluid therapy administered at day 1 reported on ideal body weight were the 5 significant variables that we combined to build a morbidity prognostic score. One patient over 4 is likely to present severe complications. A predictive morbidity score provide informative data for clinicians.
authors.affiliation: Anesthesiology and Critical Care Department, CHU Lyon Sud, Université Lyon 1, Pierre Benite, France. Electronic address: sylvain.malfroy@chu-lyon.fr.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Malfroy
authors.affiliation: Anesthesiology and Critical Care Department, CHU Lyon Sud, Université Lyon 1, Pierre Benite, France.
authors.forename: Florent
authors.initials: F
authors.lastname: Wallet
authors.affiliation: Biostatistic Unit, Hospices Civils de Lyon, F-69003, Lyon, France; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, F-69100, Villeurbanne, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Maucort-Boulch
authors.affiliation: Anesthesiology and Critical Care Department, CHU Lyon Sud, Université Lyon 1, Pierre Benite, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Chardonnal
authors.affiliation: Anesthesiology and Critical Care Department, CHU Lyon Sud, Université Lyon 1, Pierre Benite, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Sens
authors.affiliation: Anesthesiology and Critical Care Department, CHU Lyon Sud, Université Lyon 1, Pierre Benite, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Friggeri
authors.affiliation: Department of Surgical Oncology, CHU Lyon Sud, Lyon 1 University, EMR 3738, Pierre Benite, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Passot
authors.affiliation: Department of Surgical Oncology, CHU Lyon Sud, Lyon 1 University, EMR 3738, Pierre Benite, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Glehen
authors.affiliation: Anesthesiology and Critical Care Department, CHU Lyon Sud, Université Lyon 1, Pierre Benite, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Piriou
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000009:adverse effects*; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects*; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000150:complications / Q000628:therapy*; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Cytoreductive surgery; Hyperthermic intraperitoneal chemotherapy; Intensive care unit admission; Peritoneal surface malignancies; Severe complications