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Development of a risk adjustment scoring system for patients treated with cytoreductive surgery and hyperthermic
Selman Sokmen1, Yasemin Yildirim2, Cagla Dinler Sensoz1
1Dokuz Eylul University Medical Faculty, Departments of Surgery, Colorectal and Pelvic Surgery Unit, Peritoneal Surface Malignancy Center, Izmir, Turkiye.
Background:
The rate of morbidity and mortality in patients with peritoneal metastasis(PM) has decreased due to advancements in effective perioperative chemotherapy and in complex surgical techniques [Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy(CRS-HIPEC)], and preoperative optimization of patients. Despite this, PM, an apex form of advanced and complex oncological surgery platform, continues to present significant morbidity and mortality challenges. This study aimed to analyze morbidity and mortality and final oncologic outcomes with a novel hybrid HIPEC-POSSUM(H-POSSUM) scoring system, which was created by combining the newly defined HIPEC and P-POSSUM score.
Methods:
A retrospective analysis was conducted on a prospectively maintained database comprising 275 patients who underwent CRS-HIPEC. For each patient, the P-POSSUM was calculated using the 12 physiological and 6 operative variables. 106 clinico-pathological parameters were evaluated to identify factors significantly associated with morbi-mortality. The HIPEC score, a combined score by using base deficit, lactate, creatinine, platelets, C-reactive protein, and albumin, was created from the powerful significant variables. ROC analysis was performed to determine optimal cut-off values for the P-POSSUM and HIPEC scores (19.5 and 3.5, respectively). Based on these thresholds, patients were categorized and a combined risk score named H-POSSUM was developed. The key predictive performance of these novel composite modelling for morbidity and mortality was then evaluated.
Results:
The original P-POSSUM physiologic score(p < .01), HIPEC(p < .01), and H-POSSUM scores(p < .01) were crucial predictors of Clavien-Dindo (C-D) major complications. Analysis results also indicated a significant association between HIPEC score and OS(p < .01). There was a significant correlation between recurrent peritoneal disease and distant metastasis(p < .01). The number of resected organs, length of intensive care unit stay, recurrent disease, high-grade complications, preoperative neutrophil, platelet, and intraoperative albumin counts were independent powerful prognostic factors for overall survival (OS).
Conclusion:
While the H-POSSUM score demonstrated greatest predictive value for high-grade complications, the HIPEC score proved to be a robust prognostic factor for both major complications and OS.
