Textbook outcomes among patients undergoing cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy for peritoneal surface malignancies in an Eastern European population

Abstract

Background

The preferred treatment option for patients with limited peritoneal metastasis (PM) is cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC). Although the textbook outcome (TO) concept has been used in other complex surgeries, its prevalence, determinants, and effect in patients with PM remain unclear. This study aimed to identify factors influencing TO among individuals with PM undergoing CRS + HIPEC in an Eastern European population.

Methods

Between 2010 and 2023, 300 patients with PM were treated at the Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland. In this cohort, 155 patients were scheduled for CRS + HIPEC to achieve complete cytoreduction.

Results

Overall, TO achievement in the entire cohort was 56.1%. Patients with gastrointestinal or peritoneal cancers had lower odds of achieving TO than those with ovarian cancer (51.4% vs 68.2%, respectively; odds ratio [OR], 0.49; 95% CI, 0.24–1.03). Patients with a peritoneal cancer index (PCI) of ≥14 had lower odds of achieving TO than those with a PCI of <14 (31.4% vs 63.3%, respectively; OR, 0.27; 95% CI, 0.12–0.59). Achievement of completeness of cytoreduction (CCR0/1) increased the odds of TO compared with noncompleted cytoreductive (CCR ≥ 2; 63.5% vs 0.0%, respectively; OR, 64.11; 95% CI, 3.78–1086.72). The median overall survival (OS) of the entire cohort was 37.5 months. Achievement of TO was associated with decreased risk of death among patients with PM who underwent CRS + HIPEC (hazard ratio, 0.55; 95% CI, 0.34–0.88).

Conclusion

TO achievement improved OS among patients with PM who underwent CRS + HIPEC. The barriers to achieving TO included PCI of ≥14, perioperative complications, and incomplete cytoreduction.