Limited synchronous hepatic resection does not compromise peri-operative outcomes or survival after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
BACKGROUND
There is uncertainty about whether hepatic resection (HR) combined with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is effective.


METHODS
Nine hundred and thirty-five consecutive CRS/HIPEC procedures were performed between 1996 and 2016 of which 132(14%) involved concomitant HR. Peri-operative complications were graded according to the Clavien-Dindo Classification. The association of concomitant HR with 19 peri-operative outcomes and overall survival (OS) was assessed using univariate and multivariate analyses.


RESULTS
Patients undergoing HR had a lower peritoneal disease burden (peritoneal cancer index <17) (46 vs 29%, P < 0.001) and underwent a shorter operation (<9 h) (53 vs 42%, P = 0.019). After accounting for confounding factors, HR was not associated with in-hospital mortality (Relative risk [RR], 2.47; 95% confidence interval [CI], 0.52-11.77; P = 0.577) or grade III/IV morbidity (RR, 1.18; 95%CI, 0.74-1.90; P = 0.488). Moreover, HR was not associated with an increased risk of other complications on univariate or multivariate analysis. Median OS for all colorectal cancer patients was 32.3 month with resected HM versus 30.5 months without HM (P = 0.587).


CONCLUSIONS
Given prudent patient selection, concomitant HR does not compromise peri-operative outcomes or survival after CRS/HIPEC.
UNSW Department of Surgery, St George Hospital, Kogarah, New South Wales, Australia.
Akshat
A
Saxena
UNSW Department of Surgery, St George Hospital, Kogarah, New South Wales, Australia.
Sarah J
SJ
Valle
UNSW Department of Surgery, St George Hospital, Kogarah, New South Wales, Australia.
Winston
W
Liauw
UNSW Department of Surgery, St George Hospital, Kogarah, New South Wales, Australia.
David L
DL
Morris
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001063:Appendiceal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D016022:Case-Control Studies; D010478:Chemotherapy, Cancer, Regional Perfusion; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D065426:Cytoreduction Surgical Procedures; D005260:Female; D006498:Hepatectomy; D017052:Hospital Mortality; D006801:Humans; D017114:Liver Failure, Acute / Q000209:etiology; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D055815:Young Adult
cytoreductive; hepatic resection; hyperthermic; intraperitoneal; morbidity; mortality; survival