Quality Standards for Surgery of Colorectal Peritoneal Metastasis After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

• Published in: Annals of surgical oncology Vol. 29; no. 1; pp. 188 - 202
• Main Authors: García-Fadrique, Alfonso, Estevan Estevan, Rafael, Sabater Ortí, Luis
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 2022; Springer Nature B.V
• Subjects: Anastomotic leak; Chemotherapy; Clinical trials; Colorectal Neoplasms - therapy; Cytoreduction Surgical Procedures; Hemorrhage; Humans; Hyperthermic Intraperitoneal Chemotherapy; Medicine; Medicine & Public Health; Metastases; Morbidity; Oncology; Peritoneal Neoplasms - therapy; Peritoneal Surface Malignancy; Peritoneum; Quality standards; Reference Standards; Standardization; Surgery; Surgical Oncology; Surgical outcomes; Survival; Systematic review; Wound infection
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-021-10642-6

Background
The standardization of surgical outcomes throughout surgical procedures is mandatory. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) should provide proficient oncological and surgical outcomes.
Study Design
The aim of this study was to identify clinically relevant quality indicators and their quality standard, and to determine their acceptable quality limit. A systematic review on cytoreductive results from 2000 to 2018 was performed focusing on clinical guidelines, consensus conferences, and publications. After the selection of quality indicators, a systematic review of indexed references was performed in order to calculate the quality standard for each indicator.
Study Selection
Unicentric/multicentric series, comparative studies, and clinical trials. Studies were to include outcomes after cytoreduction of colorectal origin and series with more than 50 patients. Quality indicators with at least 10 series were mandatory and objective measurements were also mandatory for inclusion.
Main Outcome Measurements
Quality indicators selected were 1- to 5-year survival, overall disease-free survival, 1- to 5-year disease-free survival, complete surgical resection, duration of surgery, length of stay, overall morbimortality, major morbidity, re-intervention, postoperative hemorrhage, intestinal fistula, anastomotic leakage, wound infection, postoperative medical complications, overall recurrence, and failure to rescue.
Results
The most relevant quality indicators and critical quality limits were overall disease-free survival and 5-year overall disease-free survival (14 months and <10 months, and 14% and <4%, respectively), completeness of surgical resection (89% and <80%, respectively), overall mortality (3% and >8%, respectively), overall morbidity (47% and >63%, respectively), failure to rescue (12% and <30%, respectively), reintervention (13 and <22%, respectively), anastomotic leakage (6% and <13%, respectively), and overall recurrence (60% and <74%, respectively).
Conclusion
This is the first study to assess quality standards in CRS + HIPEC for colorectal peritoneal metastases. The current data are of particular relevance for future studies to control the variability of this surgery.