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 journalArticlepeer-review

4 Scopus citations


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 languageEnglish (US)
Pages (from-to)187-195
Number of pages9
JournalJournal of Surgical Oncology
Issue number1
StatePublished - Jan 2021

Bibliographical note

Publisher Copyright:
© 2020 Wiley Periodicals LLC


  • 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

PubMed: MeSH publication types

  • Journal Article


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