Textbook Outcomes Among Patients Undergoing CRS+HIPEC 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 combined with hyperthermic intraperitoneal chemotherapy (CRS+HIPEC).While the textbook outcome (TO) concept has been applied to other complex surgeries, its prevalence, determinants, and impact in patients with PM remain unclear. This study sought to identify factors influencing TO among individuals with PM undergoing CRS+HIPEC in an Eastern European population.

Materials and methods: Between 2010 and 2023, 300 patients with PM were treated at the Department of Surgical Oncology, Medical University of Lublin. 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 compared with individuals with ovarian cancer (51.4% vs. 68.2%; OR 0.49; 95% CI 0.24-1.03). Patients with PCI (Peritoneal Cancer Index) ≥14 had lower odds of achieving TO compared with individuals with PCI <14 (31.4% vs. 63.3%; OR 0.27; 95%CI 0.12-0.59). Achievement of completeness of cytoreduction (CCR 0/1) increased the odds of TO compared with non-completed CRS (CCR≥2, 63.5%vs.0%; OR 64.11; 95%CI 3.78-1086.72). Median overall survival (OS) for the entire cohort was 37.5 months. Achievement of TO was associated with decreased hazards of death among patients with PM undergoing CRS+HIPEC (HR 0.55; 95%CI 0.34-0.88) CONCLUSION: TO achievement improved overall survival (OS) among patients with PM undergoing CRS+HIPEC. Barriers to achieving TO included PCI ≥14, perioperative complications and incomplete cytoreduction.