A comparative outcome analysis of more than 30,000 patients from the the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) database who had undergone either cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (CS/HIPEC) or specific high-risk cancer surgery showed lower surgical complication rates with the former procedure.1 This article was published online on January 4, 2019, in JAMA Network Open.

Decisions related to the treatment of patients with peritoneal metastasis remain challenging. The use of debulking surgery to minimize tumor burden followed by the administration of heated chemotherapy within the peritoneal cavity (ie, CS/HIPEC) has achieved wide acceptance in some countries outside the United States for the treatment of patients with peritoneal metastases, although its use in the US remains low.

To assess and provide context for the complication rates associated with the CS/HIPEC procedure, the authors performed a retrospective analysis of the risks of specific wound complications, need for additional surgery, as well as 30-day mortality following treatment for the patients included in the ACS NSQIP database who had undergone CS/HIPEC compared with patients who had been treated with another high-risk surgical oncology procedure, such as right-lobe hepatectomy, trisegmental hepatectomy, pancreaticoduodenectomy (ie, Whipple procedure), or esophagectomy.

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The overall results of this comparative analysis showed CS/HIPEC to be associated with lower surgical morbidity and mortality compared with other high-risk cancer surgeries. For example, rates of 30-day mortality were 1.1% (95% confidence interval [CI], 0.6%-1.6%), 2.5% (95% CI, 2.3%-2.7%), 2.9% (95% CI,2. 4%-3.4%), 3.0% (95% CI, 2.6%-3.4%), and 3.9% (95% CI, 3.1%-4.7%) for patients undergoing CS/HIPEC, the Whipple procedure, right-lobe hepatectomy, esophagectomy, and trisegmental hepatectomy, respectively (P < .001 for comparison of CS/HIPEC vs other procedures). 

Limitations to the analysis include possible patient selection bias, as well as no evaluation of overall survival in these patient groups. However, the authors concluded that “high complication rates are a misperception from early CRS/HIPEC experience and should no longer deter referral of patients to experienced centers or impede clinical trial development in the US.”


  1. Foster JM, Sleightholm R, Patel A, et al. Morbidity and mortality rates following cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy compared with other high-risk surgical oncology procedures. JAMA Netw Open. 2019;2(1):e186847.