A novel preoperative risk score to optimize patient selection for performing concomitant liver resection with cytoreductive surgery/HIPEC

Rachel M. Lee; Adriana C. Gamboa; Michael K. Turgeon; Mohammad Y. Zaidi; Charles Kimbrough; Jennifer Leiting; Travis Grotz; Andrew J. Lee; Keith Fournier; Benjamin Powers; Sean Dineen; Joel M. Baumgartner; Jula Veerapong; Harveshp Mogal; Callisia Clarke; Gregory Wilson; Sameer Patel; Ryan Hendrix; Laura Lambert; Courtney Pokrzywa; Daniel E. Abbott; Christopher J. LaRocca; Mustafa Raoof; Jonathan Greer; Fabian M. Johnston; Charles A. Staley; Jordan M. Cloyd; Shishir K. Maithel; Maria C. Russell

doi:10.1002/jso.26239

A novel preoperative risk score to optimize patient selection for performing concomitant liver resection with cytoreductive surgery/HIPEC

Rachel M. Lee, Adriana C. Gamboa, Michael K. Turgeon, Mohammad Y. Zaidi, Charles Kimbrough, Jennifer Leiting, Travis Grotz, Andrew J. Lee, Keith Fournier, Benjamin Powers, Sean Dineen, Joel M. Baumgartner, Jula Veerapong, Harveshp Mogal, Callisia Clarke, Gregory Wilson, Sameer Patel, Ryan Hendrix, Laura Lambert, Courtney PokrzywaDaniel E. Abbott, Christopher J. LaRocca, Mustafa Raoof, Jonathan Greer, Fabian M. Johnston, Charles A. Staley, Jordan M. Cloyd, Shishir K. Maithel, Maria C. Russell

Research output: Contribution to journal › Article › peer-review

8 Scopus citations

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)
Pages (from-to)	187-195
Number of pages	9
Journal	Journal of Surgical Oncology
Volume	123
Issue number	1
DOIs	https://doi.org/10.1002/jso.26239
State	Published - Jan 2021

Bibliographical note

Publisher Copyright:
© 2020 Wiley Periodicals LLC

Keywords

Appendiceal Neoplasms/pathology
Chemotherapy, Cancer, Regional Perfusion/mortality
Colorectal Neoplasms/pathology
Combined Modality Therapy
Cytoreduction Surgical Procedures/mortality
Female
Follow-Up Studies
Hepatectomy/mortality
Humans
Hyperthermia, Induced/mortality
Male
Middle Aged
Patient Selection
Peritoneal Neoplasms/secondary
Preoperative Care
Prognosis
Risk Factors
Survival Rate

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Journal Article

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1002/jso.26239

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Lee, R. M., Gamboa, A. C., Turgeon, M. K., Zaidi, M. Y., Kimbrough, C., Leiting, J., Grotz, T., Lee, A. J., Fournier, K., Powers, B., Dineen, S., Baumgartner, J. M., Veerapong, J., Mogal, H., Clarke, C., Wilson, G., Patel, S., Hendrix, R., Lambert, L., ... Russell, M. C. (2021). A novel preoperative risk score to optimize patient selection for performing concomitant liver resection with cytoreductive surgery/HIPEC. Journal of Surgical Oncology, 123(1), 187-195. https://doi.org/10.1002/jso.26239

Lee, RM, Gamboa, AC, Turgeon, MK, Zaidi, MY, Kimbrough, C, Leiting, J, Grotz, T, Lee, AJ, Fournier, K, Powers, B, Dineen, S, Baumgartner, JM, Veerapong, J, Mogal, H, Clarke, C, Wilson, G, Patel, S, Hendrix, R, Lambert, L, Pokrzywa, C, Abbott, DE, LaRocca, CJ, Raoof, M, Greer, J, Johnston, FM, Staley, CA, Cloyd, JM, Maithel, SK & Russell, MC 2021, 'A novel preoperative risk score to optimize patient selection for performing concomitant liver resection with cytoreductive surgery/HIPEC', Journal of Surgical Oncology, vol. 123, no. 1, pp. 187-195. https://doi.org/10.1002/jso.26239

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title = "A novel preoperative risk score to optimize patient selection for performing concomitant liver resection with cytoreductive surgery/HIPEC",

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.",

keywords = "Appendiceal Neoplasms/pathology, Chemotherapy, Cancer, Regional Perfusion/mortality, Colorectal Neoplasms/pathology, Combined Modality Therapy, Cytoreduction Surgical Procedures/mortality, Female, Follow-Up Studies, Hepatectomy/mortality, Humans, Hyperthermia, Induced/mortality, Male, Middle Aged, Patient Selection, Peritoneal Neoplasms/secondary, Preoperative Care, Prognosis, Risk Factors, Survival Rate",

author = "Lee, {Rachel M.} and Gamboa, {Adriana C.} and Turgeon, {Michael K.} and Zaidi, {Mohammad Y.} and Charles Kimbrough and Jennifer Leiting and Travis Grotz and Lee, {Andrew J.} and Keith Fournier and Benjamin Powers and Sean Dineen and Baumgartner, {Joel M.} and Jula Veerapong and Harveshp Mogal and Callisia Clarke and Gregory Wilson and Sameer Patel and Ryan Hendrix and Laura Lambert and Courtney Pokrzywa and Abbott, {Daniel E.} and LaRocca, {Christopher J.} and Mustafa Raoof and Jonathan Greer and Johnston, {Fabian M.} and Staley, {Charles A.} and Cloyd, {Jordan M.} and Maithel, {Shishir K.} and Russell, {Maria C.}",

note = "Publisher Copyright: {\textcopyright} 2020 Wiley Periodicals LLC",

year = "2021",

month = jan,

doi = "10.1002/jso.26239",

language = "English (US)",

volume = "123",

pages = "187--195",

journal = "Journal of Surgical Oncology",

issn = "0022-4790",

publisher = "Wiley-Liss Inc.",

number = "1",

}

TY - JOUR

T1 - A novel preoperative risk score to optimize patient selection for performing concomitant liver resection with cytoreductive surgery/HIPEC

AU - Lee, Rachel M.

AU - Gamboa, Adriana C.

AU - Turgeon, Michael K.

AU - Zaidi, Mohammad Y.

AU - Kimbrough, Charles

AU - Leiting, Jennifer

AU - Grotz, Travis

AU - Lee, Andrew J.

AU - Fournier, Keith

AU - Powers, Benjamin

AU - Dineen, Sean

AU - Baumgartner, Joel M.

AU - Veerapong, Jula

AU - Mogal, Harveshp

AU - Clarke, Callisia

AU - Wilson, Gregory

AU - Patel, Sameer

AU - Hendrix, Ryan

AU - Lambert, Laura

AU - Pokrzywa, Courtney

AU - Abbott, Daniel E.

AU - LaRocca, Christopher J.

AU - Raoof, Mustafa

AU - Greer, Jonathan

AU - Johnston, Fabian M.

AU - Staley, Charles A.

AU - Cloyd, Jordan M.

AU - Maithel, Shishir K.

AU - Russell, Maria C.

PY - 2021/1

Y1 - 2021/1

N2 - 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.

AB - 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.

KW - Appendiceal Neoplasms/pathology

KW - Chemotherapy, Cancer, Regional Perfusion/mortality

KW - Colorectal Neoplasms/pathology

KW - Combined Modality Therapy

KW - Cytoreduction Surgical Procedures/mortality

KW - Female

KW - Follow-Up Studies

KW - Hepatectomy/mortality

KW - Humans

KW - Hyperthermia, Induced/mortality

KW - Male

KW - Middle Aged

KW - Patient Selection

KW - Peritoneal Neoplasms/secondary

KW - Preoperative Care

KW - Prognosis

KW - Risk Factors

KW - Survival Rate

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UR - http://www.scopus.com/inward/citedby.url?scp=85091787041&partnerID=8YFLogxK

U2 - 10.1002/jso.26239

DO - 10.1002/jso.26239

M3 - Article

C2 - 33002202

AN - SCOPUS:85091787041

SN - 0022-4790

VL - 123

SP - 187

EP - 195

JO - Journal of Surgical Oncology

JF - Journal of Surgical Oncology

IS - 1

ER -

A novel preoperative risk score to optimize patient selection for performing concomitant liver resection with cytoreductive surgery/HIPEC

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

UN SDGs

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