| Title: |
Half of Postoperative Deaths After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Could be Preventable A French Root Cause Analysis on 5562 Patients |
| Authors: |
Houlze-Laroye, Constance; Glehen, Olivier; Sgarbura, Olivia; Gayat, Etienne; Sourrouille, Isabelle; Tuech, Jean-Jacques; Delhorme, Jean-Baptiste; Dumont, Frederic; Ceribelli, Cecilia; Amroun, Koceila; Arvieux, Catherine; Moszkowicz, David; Pirro, Nicolas; Lefevre, Jeremie, H.; Courvosier-Clement, Thomas; Paquette, Brice; Mariani, Pascale; Pezet, Denis; Sabbagh, Charles; Tessier, Williams; Celerier, Bertrand; Guilloit, Jean-Marc; Taibi, Abdelkader; Quenet, Francois; Bakrin, Naoual; Pocard, Marc; Goéré, Diane; Brigand, Cecile; Piessen, Guillaume; Eveno, Clarisse |
| Contributors: |
Hôpital Claude Huriez Lille; Centre Hospitalier Régional Universitaire CHU Lille (CHRU Lille); Centre Hospitalier Lyon Sud CHU - HCL (CHLS); Hospices Civils de Lyon (HCL); Centre pour l'innovation en cancérologie de Lyon (CICLY); Université Claude Bernard Lyon 1 (UCBL); Université de Lyon-Université de Lyon; UNICANCER - Institut régional du Cancer Montpellier Val d'Aurelle (ICM); CRLCC Val d'Aurelle - Paul Lamarque; Institut de Recherche en Cancérologie de Montpellier (IRCM - U1194 Inserm - UM); CRLCC Val d'Aurelle - Paul Lamarque-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM); Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)); Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal Paris; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord; Service d'Anesthésie-Réanimation AP-HP Hôpitaux Saint-Louis Lariboisière; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal APHP; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité); Département de chirurgie viscérale Gustave Roussy; Institut Gustave Roussy (IGR); Service de Chirurgie Digestive CHU Rouen; CHU Rouen; Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN); Normandie Université (NU); Hôpital de Hautepierre Strasbourg; Hôpitaux Universitaires de Strasbourg (HUS); Institut de Cancérologie de l'Ouest Angers/Nantes (UNICANCER/ICO); UNICANCER; Institut de Cancérologie de Lorraine - Alexis Vautrin Nancy (UNICANCER/ICL); Hôpital Robert Debré; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital universitaire Robert Debré Reims (CHU Reims); CHU de Grenoble-Alpes - Centre Hospitalier Universitaire CHU Grenoble (CHUGA); Hôpital Louis Mourier - AP-HP Colombes; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP); CHU Saint-Antoine AP-HP; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU); Hôpital de la Timone CHU - APHM (TIMONE); Centre hospitalier universitaire de Poitiers = Poitiers University Hospital (CHU de Poitiers La Milétrie ); Service de Chirurgie Digestive CHRU Besançon; Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC); Université Bourgogne Franche-Comté COMUE (UBFC)-Université Bourgogne Franche-Comté COMUE (UBFC); Institut Curie Paris; Service Chirurgie Digestive et Hépatobiliaire CHU Clermont-Ferrand; CHU Estaing Clermont-Ferrand; CHU Clermont-Ferrand-CHU Clermont-Ferrand-Pôle Spécialités médicales et chirurgicales CHU Clermont-Ferrand; CHU Clermont-Ferrand; CHU Amiens-Picardie; Centre Régional de Lutte contre le Cancer Oscar Lambret Lille (UNICANCER/Lille); Université de Lille-UNICANCER; Hôpital Haut-Lévêque CHU Bordeaux; Centre Hospitalier Universitaire de Bordeaux (CHU Bordeaux); Centre Régional de Lutte contre le Cancer François Baclesse Caen (UNICANCER/CRLC); Normandie Université (NU)-UNICANCER; CHU Limoges; Institut régional de Cancérologie de Montpellier (ICM); Hopital Saint-Louis AP-HP (AP-HP); Hétérogénéité, Plasticité et Résistance aux Thérapies des Cancers = Cancer Heterogeneity, Plasticity and Resistance to Therapies - UMR 9020 - U 1277 (CANTHER); Institut Pasteur de Lille; Pasteur Network (Réseau International des Instituts Pasteur)-Pasteur Network (Réseau International des Instituts Pasteur)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire CHU Lille (CHRU Lille)-Centre National de la Recherche Scientifique (CNRS) |
| Source: |
ISSN: 0003-4932. |
| Publisher Information: |
CCSD; Lippincott, Williams & Wilkins |
| Publication Year: |
2021 |
| Subject Terms: |
cytoreductive surgery; HIPEC; peritoneal metastasis; peritoneal surface malignancies; postoperative mortality; root cause analysis; [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery |
| Description: |
International audience ; 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. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/34334647; PUBMED: 34334647; WOS: 000747387500031 |
| DOI: |
10.1097/SLA.0000000000005101 |
| Availability: |
https://u-picardie.hal.science/hal-03566161; https://doi.org/10.1097/SLA.0000000000005101 |
| Accession Number: |
edsbas.2974467E |
| Database: |
BASE |