T. C. Lee1, M. C. Morris1, L. K. Winer1, K. Wima1, J. Sussman1, S. Ahmad1, S. H. Patel1 1University Of Cincinnati,Surgery,Cincinnati, OH, USA
Introduction: Hyperthermic intraperitoneal chemotherapy (HIPEC) remains a formidable operation associated with considerable morbidity. It is unclear how often these patients require reoperation for post-operative complications and if the need for reoperations leads to worse long-term outcomes.
Methods: The Peritoneal Malignancy Database at a single center in the U.S. was retrospectively queried. Out of 149 entries, 141 HIPECs performed between 2012-2018 met the inclusion criteria. Patient and tumor factors were studied using univariate analyses. Reoperation details were studied on an individual case level. Recurrence data was calculated for patients with completeness of cytoreduction of 0. Overall survival analysis was also performed.
Results: There were 15 reoperations after 141 HIPECs (10.6%). Median number of days after HIPEC to reoperation was 18. Reasons for reoperation included intra-abdominal infection (n=5), bowel obstruction (n=4), wound infection (n=3), bleeding (n=2), evisceration (n=1). There were no identified patient or tumor related risk factors for reoperation, including neoadjuvant chemotherapy, prior abdominal surgery, length of surgery, peritoneal cancer index, completeness of cytoreduction, number of anastomoses, primary tumor origin, or grade of tumor. Reoperations were associated with longer hospital length of stay (19 days vs 9 days, p=0.005) and 30-day readmissions (46.7% vs 12.8%, p=0.003). There was no significant difference in recurrence rate (13.3% vs 34.9%, p=0.14) or in 3-year recurrence free survival (95.1% vs 90.0%, p=0.77), but there was a significant difference in 3-year overall survival (97.5% vs 84.4%, p=0.03).
Conclusion: These data demonstrate, for the first time, that complications requiring reoperation are more common after HIPEC than other major abdominal surgeries. These complications lead to increased short-term morbidity, longer hospital length of stay and most importantly reduced overall survival.