Where Oncologic and Surgical Complication Scoring Systems Collide: Time for a New Consensus for CRS/HIPEC

Area of Science:

• Surgical Oncology
• Peritoneal Surface Malignancies
• Clinical Outcomes Research

Background:

• Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are critical for treating peritoneal surface malignancies.
• Standardized reporting of morbidity and mortality is essential for quality comparison between centers.
• Current reporting inconsistencies arise from using both CTCAE and Clavien-Dindo classification systems.

Purpose of the Study:

• To assess and compare the Common Terminology Criteria for Adverse Events (CTCAE) and Clavien-Dindo classification systems for grading complications after CRS/HIPEC.
• To evaluate the accuracy, simplicity, and time efficiency of each system among different medical professionals.

Main Methods:

• A retrospective analysis of complications in 147 patients undergoing CRS/HIPEC.
• Independent grading of complications by an expert board using both CTCAE and Clavien-Dindo systems.
• Evaluation of twelve real-world complications by residents, experienced surgeons, and medical oncologists using both classification systems.

Main Results:

• The overall complication rate was 37%, with a reoperation rate of 6.8% and a mortality rate of 2%.
• CTCAE classification resulted in a significantly higher major morbidity rate (25%) compared to Clavien-Dindo (8%).
• Medical professionals assessed complications more accurately and found the Clavien-Dindo system simpler and faster to use.

Conclusions:

• The CTCAE and Clavien-Dindo classifications yield different interpretations of complication severity after CRS/HIPEC.
• The Clavien-Dindo classification appears more suitable for assessing surgical outcomes in this patient population.
• A consensus on a standardized reporting language is crucial for comparing surgical outcomes in CRS/HIPEC centers.