Hepatic resection and blood transfusion increase morbidity after cytoreductive surgery and HIPEC for colorectal carcinom
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RESEARCH ARTICLE
Hepatic resection and blood transfusion increase morbidity after cytoreductive surgery and HIPEC for colorectal carcinomatosis C. Soldevila‑Verdeguer1,2 · J. J. Segura‑Sampedro1,2,3 · C. Pineño‑Flores1,2 · P. Sanchís‑Cortés2 · X. González‑Argente1,2,3 · R. Morales‑Soriano1,2 Received: 9 December 2019 / Accepted: 19 March 2020 © Federación de Sociedades Españolas de Oncología (FESEO) 2020
Abstract Background and objectives Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is an effective but complex treatment for peritoneal metastasis (PM). Our objective was to identify risk factors for postoperative morbidity and mortality following CRS-HIPEC. Methods Retrospective study of prospectively collected data of patients undergoing CRS-HIPEC for PM arises from colorectal cancer between January 2008 and December 2017. Perioperative variables were correlated with morbidity outcomes using a logistic regression model. Results Sixty-seven patients underwent CRS-HIPEC, and overall morbidity and mortality were 31.3% and 4.5% respectively. Major morbidity rate was 19.4%; 7.5% of patients were re-operated. Intraoperative blood transfusion (p = 0.01), liver resection (p 10), liver resection in the same surgery, and perioperative blood transfusion. Type of cytostatic agent, number of anastomosis, stoma creation, tumor histology, age, gender, ECOG, and ASA were analysed as control variables. Chi-square test was used to compare dichotomous variables, and continuous variables were compared with Student’s T test or Mann–Whitney U test. Univariate and multivariate logistic regression was performed to identify potential morbidity predictors. The statistical significance threshold was set at p 10 Number of visceral resections 0–2 > 2 Number of peritonectomies 0–1 > 1 Simultaneous liver resection Yes No Digestive anastomoses Yes No CC-score 0 1 Stoma realization Yes No Intraperitoneal drug Oxaliplatin Mitomycin C Intraoperative blood transfusion Yes No
13 (28.3) 8 (38.1)
0.42
7 (15.2) 6 (28.6)
0.20
6 (23.1) 15 (36.6)
0.24
8 (24.2) 5 (14.7)
0.32
5 (18.5) 16 (40.0)
0.06
0 13 (22.0)
0.14
8 (61.5) 13 (24.1)
0.009
5 (38.5) 8 (14.8)
0.05
20 (40.8) 1 (5.6)
0.006
12 (24.5) 1 (5.6)
0.08
20 (32.3) 1 (20%)
0.57
12 (19.4) 1 (20.0)
0.97
19 (30.2) 2 (50.0)
0.41
2 (50.0) 11 (17.5)
0.11
2 (16.7) 19 (34.5)
0.23
11 (20.0) 2 (16.7)
0.79
14 (48.3) 7 (18.4)
0.01
8 (27.6) 5 (13.2)
0.14
Bold indicates statistically significant
Table 5 Univariate and multivariate analyses of factors influencing morbidity
Prognostic factor
Simultaneous liver resection Intraoperative blood transfusion > 2 RBC units Digestive anastomosis
Univariate analysis
Multivariate analysis
Odds ratio
CI (95%)
p
Odds ratio
IC (95%)
p
5.05 4.13 13.74 11.724
1.40–18.14 1.38–12.38 3.68–51.16 1.44–95.33
0.013 0.011 0.001 0.021
4.33 3.66
1.13–16.54 1.17–11.46
0.032 0.026
Bold indicates statistically significant RBC red blood cells
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