A retrospective analysis of postoperative complications in Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy surgery: [CHERRY (Complications of HipEc suRgeRY)]

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a comprehensive treatment option performed for peritoneal surface malignancies (PSM), both primary peritoneal cancers and peritoneal metastasis secondary to colorectal, appendiceal, ovarian, gastric and other malignancies. CRS is performed to treat macroscopic disease and HIPEC is used to treat microscopic residual disease with the intent to treat the PC by a single procedure, CRS comprises the surgical removal of visible tumour from peritoneal surfaces as well as abdomino-pelvic organs. CRS includes a wide spectrum which ranges from excision of a single peritoneal nodule to complete peritonectomy along with multi-visceral resections and up to 3-5 anastomoses. It is followed by HIPEC which involves pumping highly concentrated chemotherapy drugs heated to 41°C - 43°C into the peritoneal cavity. HIPEC can be performed either with closed or open abdominal techniques. The primary disease and institutional protocol dictate the type of HIPEC treatment used in various institutes. The duration of surgery can vary from eight to fifteen hours, with longer duration being the norm rather than an exception.

CRS-HIPEC is a complex procedure with some life-threatening complications in the immediate postoperative period, reported morbidity rates between 12%-60% and a mortality rate of 0.9%-5.8%. The postsurgical complications have been reported as late as 90 d after surgery. Percentage of these complications, morbidity and mortality outcomes varies in different studies and those depends on many factors like primary malignancy, extent of metastasis, patient related factors, perioperative management. Over the years since its introduction in 1980, better patient selection, improvements in surgical techniques, surgical skills and perioperative management strategies, have further reduced the morbidity and improved the survival.

Several studies found reduction of morbidity and mortality over time, stressing the importance of the learning curve principle [3,4,5]. studies like Terence C.Chua et.al. have analysed impact of clinical and treatment-related variables on complications and outcomes, Andrew D. Newton et.al. found in there review study that CRS and HIPEC is performed at experienced high volume centers, can be associated with long term survival with acceptable morbidity and mortality rates. Our institute doing CRS-HIPEC surgeries since 2015 with optimal number of surgeries per year, hence decided to study on the complications in CRSHIPEC surgery and impact of risk factors associated with morbidity and mortality

For the purpose of description, these complications have been grouped into Medical complications like Respiratory, Cardiovascular, Renal and pelvicalyceal system, Central nervous system complications like delirium, Hepatobilliary and gastrointestinal, Hematological, Sepsis : cause by central line, foleys catheter etc Venous thromboembolism : pulmonary embolism and deep venous thrombosis and others. Surgical complication like Intra-abdominal complications like Gastrointestinal anastomotic leak, fistula, Stoma complications, Abdominal wall / surgical site, Need of reexploration, Radiological intervention like pigtail insertion.