Effectiveness and failures of a fast track protocol after cytoreduction and hyperthermic intraoperative intraperitoneal chemotherapy in patients with peritoneal surface malignancies

• Published in: Surgical oncology 2016-12, Vol.25 (4), p.349-354
• Main Authors: Cascales-Campos, P.A, Sánchez-Fuentes, P.A, Gil, J, Gil, E, López-López, V, Rodriguez Gomez-Hidalgo, N, Fuentes, D, Parrilla, P
• Format: Article
• Language: English
• Subjects: Abdomen; Blood transfusions; Cancer therapies; Chemotherapy; Chemotherapy, Cancer, Regional Perfusion; Clinical Protocols - standards; Combined Modality Therapy; Cytoreduction Surgical Procedures - methods; Failure; Fast track protocol; Gastrointestinal surgery; Hematology, Oncology and Palliative Medicine; HIPEC; Hospitals; Humans; Hyperthermia, Induced - methods; Morbidity; Mortality; Multivariate analysis; Ovarian cancer; Patients; Peritoneal Neoplasms - therapy; Peritoneal surface malignancies; Surgery
• ISSN: 0960-7404; 1879-3320
• DOI: 10.1016/j.suronc.2016.08.001

Abstract Background The aim of this study was to analyze the results short term perioperative of patients with peritoneal surface malignancies undergoing cytoreduction with peritonectomy and HIPEC under a controlled fast track protocol and evaluate the factors related to the failure of implementation of the protocol. Patients and method We prospectively analyzed a consecutive series of patients (N = 156) with peritoneal surface malignancies treated by cytoreductive surgery with peritonectomy procedures and HIPEC from September 2008 until December 2014, in whom a fast track protocol was implemented. We limited the protocol to patients who had optimal cytoreduction, HIPEC administration, and not more than one digestive anastomosis. All patients signed informed consent for surgery and the perioperative multimodal recovery program. Results A total of 156 consecutive patients, with a median age of 57 years were included in the study. Median PCI was 8 (IQR: 0–32). Morbidity rate (Clavien-Dindo) was 25.6%, with a major morbidity rate (Clavien-Dindo III-IV) of 11.5%. One hundred and three patients (66%) completed the protocol. Multivariate analysis identified the following independent factors, which were related to failure of the protocol: age over 57 years (OR = 3.159, 95% CI: 1.286–7.758, p