title: Major Postoperative Complications Are a Risk Factor for Impaired Survival after CRS/HIPEC.
abstract: BACKGROUND
  Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a combined treatment option for well-selected patients with peritoneal carcinomatosis (PC). The study aimed to identify factors influencing cancer-specific survival (CSS) and disease-free survival (DFS).
  
  
  METHODS
  Data of 113 patients with colorectal or appendicular carcinomatosis from a single center operated between 2009 and 2014 were retrospectively collected and analyzed. Patients with high-grade tumors received standard perioperative chemotherapy, and patients with low-grade appendix tumors were directly operated. HIPEC was performed after radical CRS.
  
  
  RESULTS
  Patients had carcinomatosis from appendix neoplasms in 63% (71/113), including low-grade and high-grade tumors, and colorectal cancer in 37% (42/113). Complete cytoreduction and HIPEC were possible in 67% of patients. Major morbidity occurred in 10.6% of patients, and mean follow-up was 28 months. For colorectal PC, median CSS and DFS were 40 and 12 months, respectively. Median DFS was 19 months for high-grade appendix tumors, while median CSS has not been reached. All patients with diffuse peritoneal adenomucinosis were still alive at time of analysis; rate of DFS was 96% for these patients after 3 years. Major postoperative complications (Clavien-Dindo IIIB or higher) and positive nodal state were associated with impaired CSS and DFS, while a peritoneal cancer index score of >10 was independently associated with impaired CSS.
  
  
  CONCLUSIONS
  CRS/HIPEC offers a survival benefit in well-selected patients with PC. Major postoperative complications affect long-term oncologic outcome of these patients.
authors.affiliation: Department of Visceral and Transplantation Surgery, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Marcel André
authors.initials: MA
authors.lastname: Schneider
authors.affiliation: Department of Visceral and Transplantation Surgery, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Dilmurodjon
authors.initials: D
authors.lastname: Eshmuminov
authors.affiliation: Department of Visceral and Transplantation Surgery, University Hospital of Zurich, Zurich, Switzerland. Kuno.Lehmann@usz.ch.
authors.forename: Kuno
authors.initials: K
authors.lastname: Lehmann
mesh_terms: D000328:Adult; D001063:Appendiceal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D010478:Chemotherapy, Cancer, Regional Perfusion; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D065426:Cytoreduction Surgical Procedures / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D010534:Peritoneal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate