Abstract
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.
Original language | English (US) |
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Pages (from-to) | 187-195 |
Number of pages | 9 |
Journal | Journal of Surgical Oncology |
Volume | 123 |
Issue number | 1 |
DOIs | |
State | Published - Jan 2021 |
Bibliographical note
Publisher Copyright:© 2020 Wiley Periodicals LLC
Keywords
- HIPEC
- appendiceal adenocarcinoma
- colorectal cancer
- liver resection
- risk score