Half of Postoperative Deaths After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Could be Preventable
Constance Houlzé-Laroye
(1)
,
Olivier Glehen
(2)
,
Olivia Sgarbura
(3)
,
Etienne Gayat
(4, 5, 6, 7)
,
Isabelle Sourrouille
(8)
,
Jean-Jacques Tuech
(9)
,
Jean-Baptiste Delhorme
(10)
,
Frédéric Dumont
,
Cécilia Ceribelli
(11)
,
Koceila Amroun
(12)
,
Catherine Arvieux
(13)
,
David Moszkowicz
(14)
,
Nicolas Pirro
(15)
,
Jérémie Lefevre
(16)
,
Thomas Courvosier-Clement
(17)
,
Brice Paquette
(18)
,
Pascale Mariani
(19)
,
Denis Pezet
(20)
,
Charles Sabbagh
(21, 22)
,
Williams Tessier
(23)
,
Bertrand Celerier
,
Jean-Marc Guilloit
,
Abdelkader Taibi
(24, 25)
,
François Quenet
,
Naoual Bakrin
,
Marc Pocard
,
Diane Goéré
,
Cécile Brigand
,
Guillaume Piessen
,
Clarisse Eveno
1
Hôpital Claude Huriez [Lille]
2 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
3 ICM - UNICANCER - Institut régional du Cancer Montpellier Val d'Aurelle
4 MASCOT (UMR_S_942 / U942) - Marqueurs cardiovasculaires en situation de stress
5 Service de Réanimation Médicale et Toxicologique [Hôpital Lariboisière]
6 OPTeN (UMR_S 1144 / U1144) - Optimisation thérapeutique en Neuropsychopharmacologie
7 Centre hospitalier Saint-Joseph [Paris]
8 Département de chirurgie viscérale [Gustave Roussy]
9 Service de Chirurgie Digestive [CHU Rouen]
10 IRFAC - Inserm U1113 - Interface de Recherche Fondamentale et Appliquée en Cancérologie
11 UNICANCER/ICL - Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy]
12 Hôpital Robert Debré
13 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
14 DHNS - Maladies et hormones du système nerveux
15 TIMONE - Hôpital de la Timone [CHU - APHM]
16 CHU Saint-Antoine [AP-HP]
17 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
18 Service de Chirurgie Digestive [CHRU Besançon]
19 Institut Curie [Paris]
20 M2iSH - Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte
21 CHU Amiens-Picardie
22 SSPC - Simplification des soins chez les patients complexes - UR UPJV 7518
23 UNICANCER/Lille - Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille]
24 XLIM - XLIM
25 CHU Limoges
2 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
3 ICM - UNICANCER - Institut régional du Cancer Montpellier Val d'Aurelle
4 MASCOT (UMR_S_942 / U942) - Marqueurs cardiovasculaires en situation de stress
5 Service de Réanimation Médicale et Toxicologique [Hôpital Lariboisière]
6 OPTeN (UMR_S 1144 / U1144) - Optimisation thérapeutique en Neuropsychopharmacologie
7 Centre hospitalier Saint-Joseph [Paris]
8 Département de chirurgie viscérale [Gustave Roussy]
9 Service de Chirurgie Digestive [CHU Rouen]
10 IRFAC - Inserm U1113 - Interface de Recherche Fondamentale et Appliquée en Cancérologie
11 UNICANCER/ICL - Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy]
12 Hôpital Robert Debré
13 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
14 DHNS - Maladies et hormones du système nerveux
15 TIMONE - Hôpital de la Timone [CHU - APHM]
16 CHU Saint-Antoine [AP-HP]
17 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
18 Service de Chirurgie Digestive [CHRU Besançon]
19 Institut Curie [Paris]
20 M2iSH - Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte
21 CHU Amiens-Picardie
22 SSPC - Simplification des soins chez les patients complexes - UR UPJV 7518
23 UNICANCER/Lille - Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille]
24 XLIM - XLIM
25 CHU Limoges
Olivier Glehen
- Function : Author
- PersonId : 1359956
- ORCID : 0000-0002-2802-4974
- IdRef : 120001845
Frédéric Dumont
- Function : Author
Charles Sabbagh
- Function : Author
- PersonId : 1151816
- ORCID : 0000-0001-7525-0627
- IdRef : 154808261
Bertrand Celerier
- Function : Author
Jean-Marc Guilloit
- Function : Author
François Quenet
- Function : Author
Naoual Bakrin
- Function : Author
Marc Pocard
- Function : Author
Diane Goéré
- Function : Author
Cécile Brigand
- Function : Author
Guillaume Piessen
- Function : Author
Clarisse Eveno
- Function : Author
Abstract
Objective: To perform a retrospective root-cause analysis of postoperative death after CRS and HIPEC procedures. Background: The combination of CRS and HIPEC is an effective therapeutic strategy to treat peritoneal surface malignancies, however it is associated with significant postoperative mortality. Methods: All patients treated with a combination of CRS and HIPEC between January 2009 and December 2018 in 22 French centers and died in the hospital, were retrospectively analyzed. Perioperative data of the 101 patients were collected by a local senior surgeon with a sole junior surgeon. Three independent experts investigated the typical root cause of death and provided conclusions on whether postoperative death was preventable (PREV group) or not (NON-PREV group). A typical root cause of preventable postoperative death was classified on a cause-and-effect diagram. Results: Of the 5562 CRS+HIPEC procedures performed, 101 in-hospital deaths (1.8%) were identified, of which a total of 18 patients of 70 years old and above and 20 patients with ASA score of 3. Etiology of peritoneal disease was mainly colorectal. A total of 54 patients (53%) were classified in the PREV group and 47 patients (47%) in the NON-PREV group. The results of the study show that in the PREV group, WHO performance status 1-2 was more frequent and the Median Peritoneal Cancer Index was higher compared with those of the NON-PREV group. The cause of death in the PREV group was classified as: (i) preoperatively for debatable indication (59%), (ii) intraoperatively (30%) and (iii) postoperatively in 17 patients (31%). A multifactorial cause of death was found in 11 patients (20%). Conclusion: More than half of the postoperative deaths after combined CRS and HIPEC may be preventable, mainly by following guidelines regarding preoperative selection of the patients and adequate intraoperative decisions.