title: No impact on long-term survival of prolonged ICU stay and re-admission for patients undergoing cytoreductive surgery with HIPEC.
abstract: Cytoreductive surgery (CRS) and Hyperthermic intraperitoneal chemotherapy (HIPEC) are promising new approaches of peritoneal metastases. However these surgical procedures are associated with a high morbidity rate thus intensive care (IC) management following serious complications may be warranted for these patients. The impact of the prolonged IC stay or re-admission on long-term survival remains unknown.
  
  
  
  We retrospectively analysed 122 consecutive HIPEC procedures over a one year period (2010-2011) in a single academic hospital. We analysed complications that would lead to prolonged stay or re-admission into ICU and analysed long term follow-up in patients whether they required intensive care (ICU group) or not (Control group).
  
  
  
  ICU group represented 26.2% of the cohort mainly due to septic or haemorrhagic shock. Among them acute kidney injury and respiratory failure were present in 50% and 47% respectively. Cohort overall mortality rate was of 5.7%. Patients were followed for 4 years and survival analysis was performed adjusting for main confounding factors in a Cox survival model. Survival was not different between groups, with a median survival of 38 months [32; 44] vs. 33 months [26; 39] in the ICU group and Control group respectively.
  
  
  
  Prolonged stay or re-admission into ICU does not seem to statistically impact long term prognosis of patients undergoing CRS with HIPEC.
authors.affiliation: Critical Care and Anaesthesiology Department, CHU Lyon Sud, University Lyon 1, Pierre Benite, France; Laboratoire des Pathogènes Emergents, Centre International de Recherche en Infectiologie, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, France. Electronic address: florent.wallet@chu-lyon.fr.
authors.forename: F
authors.initials: F
authors.lastname: Wallet
authors.affiliation: Université de Lyon, Lyon, France; Hospices Civils de Lyon, Service de Biostatistique, Lyon, France; CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, F-69100, France.
authors.forename: D
authors.initials: D
authors.lastname: Maucort Boulch
authors.affiliation: Critical Care and Anaesthesiology Department, CHU Lyon Sud, University Lyon 1, Pierre Benite, France.
authors.forename: S
authors.initials: S
authors.lastname: Malfroy
authors.affiliation: Critical Care and Anaesthesiology Department, CHU Lyon Sud, University Lyon 1, Pierre Benite, France.
authors.forename: S
authors.initials: S
authors.lastname: Ledochowski
authors.affiliation: Critical Care and Anaesthesiology Department, CHU Lyon Sud, University Lyon 1, Pierre Benite, France.
authors.forename: C
authors.initials: C
authors.lastname: Bernet
authors.affiliation: Department of Surgical Oncology, CHU Lyon Sud, Université Lyon 1, EMR 3738, Pierre Bénite, France.
authors.forename: V
authors.initials: V
authors.lastname: Kepenekian
authors.affiliation: Department of Surgical Oncology, CHU Lyon Sud, Université Lyon 1, EMR 3738, Pierre Bénite, France.
authors.forename: G
authors.initials: G
authors.lastname: Passot
authors.affiliation: Critical Care and Anaesthesiology Department, CHU Lyon Sud, University Lyon 1, Pierre Benite, France.
authors.forename: O
authors.initials: O
authors.lastname: Vassal
authors.affiliation: Critical Care and Anaesthesiology Department, CHU Lyon Sud, University Lyon 1, Pierre Benite, France.
authors.forename: V
authors.initials: V
authors.lastname: Piriou
authors.affiliation: Department of Surgical Oncology, CHU Lyon Sud, Université Lyon 1, EMR 3738, Pierre Bénite, France.
authors.forename: O
authors.initials: O
authors.lastname: Glehen
authors.affiliation: Critical Care and Anaesthesiology Department, CHU Lyon Sud, University Lyon 1, Pierre Benite, France; Laboratoire des Pathogènes Emergents, Centre International de Recherche en Infectiologie, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, France.
authors.forename: A
authors.initials: A
authors.lastname: Friggeri
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D007362:Intensive Care Units; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms; D015996:Survival Rate
keywords: Cytoreductive surgery; HIPEC; Intensive care unit; Long term outcome; Prognosis