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A novel preoperative risk score to optimize patient selection for performing concomitant liver resection with cytoreductive surgery/HIPEC
- Lee, Rachel M;
- Gamboa, Adriana C;
- Turgeon, Michael K;
- Zaidi, Mohammad Y;
- Kimbrough, Charles;
- Leiting, Jennifer;
- Grotz, Travis;
- Lee, Andrew J;
- Fournier, Keith;
- Powers, Benjamin;
- Dineen, Sean;
- Baumgartner, Joel M;
- Veerapong, Jula;
- Mogal, Harveshp;
- Clarke, Callisia;
- Wilson, Gregory;
- Patel, Sameer;
- Hendrix, Ryan;
- Lambert, Laura;
- Pokrzywa, Courtney;
- Abbott, Daniel E;
- LaRocca, Christopher J;
- Raoof, Mustafa;
- Greer, Jonathan;
- Johnston, Fabian M;
- Staley, Charles A;
- Cloyd, Jordan M;
- Maithel, Shishir K;
- Russell, Maria C
Published Web Location
https://doi.org/10.1002/jso.26239Abstract
Background
While parenchymal hepatic metastases were previously considered a contraindication to cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC), liver resection (LR) is increasingly performed with CRS/HIPEC.Methods
Patients from the US HIPEC Collaborative (2000-2017) with invasive appendiceal or colorectal adenocarcinoma undergoing primary, curative intent CRS/HIPEC with CC0-1 resection were included. LR was defined as a formal parenchymal resection. Primary endpoints were postoperative complications and overall survival (OS).Results
A total of 658 patients were included. About 83 (15%) underwent LR of colorectal (58%) or invasive appendiceal (42%) metastases. LR patients had more complications (81% vs. 60%; p = .001), greater number of complications (2.3 vs. 1.5; p < .001) per patient and required more reoperations (22% vs. 11%; p = .007) and readmissions (39% vs. 25%; p = .014) than non-LR patients. LR patients had decreased OS (2-year OS 62% vs. 79%, p < .001), even when accounting for peritoneal carcinomatosis index and histology type. Preoperative factors associated with decreased OS on multivariable analysis in LR patients included age < 60 years (HR, 3.61; 95% CI, 1.10-11.81), colorectal histology (HR, 3.84; 95% CI, 1.69-12.65), and multiple liver tumors (HR, 3.45; 95% CI, 1.21-9.85) (all p < .05). When assigning one point for each factor, there was an incremental decrease in 2-year survival as the risk score increased from 0 to 3 (0: 100%; 1: 91%; 2: 58%; 3: 0%).Conclusions
As CRS/HIPEC + LR has become more common, we created a simple risk score to stratify patients considered for CRS/HIPEC + LR. These data aid in striking the balance between an increased perioperative complication profile with the potential for improvement in OS.Many UC-authored scholarly publications are freely available on this site because of the UC's open access policies. Let us know how this access is important for you.
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