Predictive Factors for Intensive Care Unit Admission After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy in Patients with Peritoneal Disease: A Single Center Retrospective Review

Abstract

Introduction: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS+HIPEC) is a locoregional surgical therapy applied in patients with peritoneal-only metastatic disease of primary abdominal malignancies and is associated with increased overall survival. Our goal was to evaluate short-term outcomes after CRS+HIPEC regarding surgical morbidity, as well as to identify factors associated with selective Intensive Care Unit (ICU) admission and to assess the safety of managing these patients outside of the ICU.
Methods: A unicentric, retrospective, observational study of patients submitted to CRS+HIPEC between January 2016 and December 2020 at Instituto Português de Oncologia do Porto (IPO-Porto), was performed.
Results: During this period, 259 surgeries were performed. The majority of patients (68.7%) had no complications, 22.8% had CT-CAE 1/2 complications, 7.7% had CT-CAE 3/4 and 0.8% (n=2) died in the first 30 days postoperative (CT-CAE 5). Thirty-four percent (n=87) of patients were admitted to the ICU for postoperative surveillance (<48 hours). Patients who were not admitted to ICU demonstrated similar overall morbidity to the patients admitted to ICU for <48 hours. Predictive factors for ICU admission (p<0.05) were PCI>13, intraoperative blood loss>200 mL and cisplatin as the cytostatic agent.
Conclusion: Admittance to the ICU should not be standardized for every patient after CRS+HIPEC but rather stratified according to the complexity of surgical debulking.