SSAT - SAFETY OF SYNCHRONOUS LIVER RESECECTION WITH CYTOREDUCTIVE SURGERY AND HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY: AN ACS-NSQUIP ANALYSIS

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SAFETY OF SYNCHRONOUS LIVER RESECECTION WITH CYTOREDUCTIVE SURGERY AND HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY: AN ACS-NSQUIP ANALYSIS
Jordan Cloyd^*, Sherif Abdel-Misih, John Hays, Mary Dillhoff, Timothy M. Pawlik, Carl Schmidt
Surgery, OHIO STATE UNIVERSITY, Columbus, OH

Introduction: While liver resection (LR) and cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) are commonly performed for metastatic colorectal cancer with hepatic and peritoneal metastases, respectively, the safety of synchronous LR and CRS-HIPEC has not been established.

Methods: The ACS-NSQIP databases from 2005-2016 were used to identify patients who underwent CRS-HIPEC. Demographic, clinical, and perioperative outcomes were compared among patients who underwent CRS-HIPEC with and without synchronous LR.

Results: Among 1,168 patients who underwent CRS-HIPEC, 100 (8.6%) underwent synchronous LR and 1,068 (91.4%) did not. There were no differences in demographics or comorbidities among patients who underwent CRS-HIPEC with or without LR (all p>0.05). The most common primary diagnosis was unspecified (65.3%) followed by appendix (16.0%) and colorectal (12.5%). Among patients who underwent CRS-HIPEC plus LR, the majority had a partial hepatectomy (96.0%), while few underwent trisegmentectomy (2.0%) or hemihepatectomy (2.0%). Patients who underwent CRS-HIPEC plus LR underwent a greater number of operative procedures, defined as number of listed CPT codes (8.3 ± 2.5 vs 6.7± 2.5, p<0.001), had a longer operative time (520.7 ± 155.3 vs 454.6 ± 160.7 min, p=0.001), had a longer hospital length of stay (16.7 ± 15.6 vs 11.1 ± 11.5 days, p<0.001), and were more likely to require reoperation (13.0% vs 6.9%, p=0.03). On univariate analysis, overall 30 day morbidity (47.0% vs 27.4%, p<0.001), but not mortality (3.0% vs 1.4%, p=0.22), was higher among patients undergoing CRS-HIPEC plus LR. On multivariate logistic regression, LR remained strongly associated with increased risk of postoperative morbidity even after controlling for potential confounders (OR 1.65, 95% CI 1.03-2.64).

Conclusion: Simultaneous LR and CRS-HIPEC is associated with increased operative time, length of hospital stay, reoperation and postoperative morbidity compared to CRS-HIPEC alone. For patients with synchronous hepatic and peritoneal metastases, a staged operative approach should be considered.

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