Toxicity of cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy

Background and Objectives Cytoreduction with hyperthermic intra‐peritoneal chemotherapy (HIPEC) is a treatment with a high morbidity. Optimal patients selection can possible reduce toxicity and complications. Patients and Methods Complications and toxicity of 102 patients were studied. Toxicity was graded according National Cancer Institute Common Toxicity Criteria (NCI CTC) classification. A complication was defined as any post‐operative event that needed re‐intervention. Potential patients, tumor, and treatment factors were studied on their relation to complications. Results Grade 3, 4, or 5 toxicity was observed in 66 patients (65%). Eight patients died of treatment‐related causes. Surgical complications occurred in 36 patients (35%). Fistulae were frequently encountered (18 patients). The risk of a complicated recovery was higher in carcinomatosis with recurrent colorectal cancer (P = 0.009) and in the case of more than five regions affected (P = 0.044), who had a Simplified Peritoneal Cancer (SPC) score of 13 (P = 0.012) and with an incomplete initial cytoreduction (P = 0.035). Patients with blood loss exceeding 6 L (P = 0.028) and those with three or more anastomoses also had an increased post‐operative complication rate (P = 0.018). Conclusions Toxicity of cytoreduction followed by HIPEC was 65% (Grade 3–5 NCI CTC), with a surgical complication rate of 35%. Patients with six or seven regions involved and those in whom complete cytoreduction cannot be reached are probably better off without this treatment. J. Surg. Oncol. 2004;85:61–67. © 2004 Wiley‐Liss, Inc.