A. Z. Paredes1, F. A. Guzman-Pruneda1, S. Abdel-Misih1, J. Hays2, M. E. Dillhoff1, T. M. Pawlik1, J. M. Cloyd1 1Ohio State University,Department Of Surgery, Division Of Surgical Oncology,Columbus, OH, USA 2Ohio State University,Department Of Internal Medicine, Division Of Medical Oncology,Columbus, OH, USA
Introduction: Formal gastrectomy, at times, is required in order to achieve complete cytoreduction for patients with peritoneal surface malignancies. In addition, the role of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with gastric cancer is increasingly being explored. Nevertheless, data on the safety of gastrectomy at the time of CRS-HIPEC is limited.
Methods: The ACS-NSQIP databases from 2005-2016 were used to identify patients who underwent CRS-HIPEC. Demographic, clinical, and perioperative outcomes were compared between patients who underwent CRS-HIPEC with and without gastrectomy.
Results: Among 1,168 patients who underwent CRS-HIPEC, 43 (4%) underwent partial (n=20) or total (n=23) gastrectomy. Patients who underwent gastrectomy at the time of CRS-HIPEC had a longer operative time (529.3 vs, 457.6 min, P=0.004), were more likely to need an intraoperative transfusion (32.6% vs. 14.3%, P=0.001), experienced a longer length of stay (19.0 vs. 11.3d, P<0.001), and had a significantly greater complication rate (60.5% vs. 27.9%, P<0.001) whereas postoperative mortality was not statistically significantly different (4.7% vs. 1.4%, P=0.09). On multivariate logistic regression, gastrectomy (OR 3.52, P<0.001) was the strongest predictor of postoperative morbidity, in addition to ASA class 4 (OR 2.82, P=0.001), malnutrition (OR 1.63, P=0.01), liver resection (OR 1.88, P=0.01) and colectomy (OR 2.04, P<0.001).
Conclusion: Patients undergoing gastrectomy at the time of CRS-HIPEC experience a substantial postoperative complication rate (60%) and extended length of stay (mean 19 days). These findings highlight the need for cautious patient selection and preoperative counseling prior to performing concomitant gastrectomy and CRS-HIPEC. Future clinical trials investigating the role of HIPEC for gastric cancer should continue to stringently evaluate short-term morbidity in addition to long-term oncologic outcomes.