Half of Postoperative Deaths After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Could be Preventable A French Root Cause Analysis on 5562 Patients
Constance Houlze-Laroye
(1)
,
Olivier Glehen
(2, 3)
,
Olivia Sgarbura
(4, 5)
,
Etienne Gayat
(6, 7)
,
Isabelle Sourrouille
(8)
,
Jean-Jacques Tuech
(9)
,
Jean-Baptiste Delhorme
(10)
,
Frederic Dumont
(11)
,
Cecilia Ceribelli
(12)
,
Koceila Amroun
(13)
,
Catherine Arvieux
(14)
,
David Moszkowicz
(15, 16)
,
Nicolas Pirro
(17)
,
Jeremie H. Lefevre
(16)
,
Thomas Courvosier-Clement
(18)
,
Brice Paquette
(19)
,
Pascale Mariani
(20)
,
Denis Pezet
(21)
,
Charles Sabbagh
(22)
,
Williams Tessier
(23)
,
Bertrand Celerier
(24)
,
Jean-Marc Guilloit
(25)
,
Abdelkader Taibi
(26)
,
Francois Quenet
(27)
,
Naoual Bakrin
(2, 3)
,
Marc Pocard
,
Diane Goéré
(28)
,
Cecile Brigand
(10)
,
Guillaume Piessen
(1, 29)
,
Clarisse Eveno
(1, 29)
1
Hôpital Claude Huriez [Lille]
2 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
3 CICLY - Centre pour l'innovation en cancérologie de Lyon
4 ICM - UNICANCER - Institut régional du Cancer Montpellier Val d'Aurelle
5 IRCM - U1194 Inserm - UM - Institut de Recherche en Cancérologie de Montpellier
6 MASCOT (UMR_S_942 / U942) - Marqueurs cardiovasculaires en situation de stress
7 Service d'Anesthésie-Réanimation [AP-HP Hôpitaux Saint-Louis Lariboisière]
8 Département de chirurgie viscérale [Gustave Roussy]
9 Service de Chirurgie Digestive [CHU Rouen]
10 Hôpital de Hautepierre [Strasbourg]
11 UNICANCER/ICO - Institut de Cancérologie de l'Ouest [Angers/Nantes]
12 UNICANCER/ICL - Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy]
13 Hôpital Robert Debré
14 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
15 Hôpital Louis Mourier - AP-HP [Colombes]
16 CHU Saint-Antoine [AP-HP]
17 TIMONE - Hôpital de la Timone [CHU - APHM]
18 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
19 Service de Chirurgie Digestive [CHRU Besançon]
20 Institut Curie [Paris]
21 Service Chirurgie Digestive et Hépatobiliaire [CHU Clermont-Ferrand]
22 CHU Amiens-Picardie
23 UNICANCER/Lille - Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille]
24 Hôpital Haut-Lévêque [CHU Bordeaux]
25 UNICANCER/CRLC - Centre Régional de Lutte contre le Cancer François Baclesse [Caen]
26 CHU Limoges
27 ICM - Institut régional de Cancérologie de Montpellier
28 AP-HP - Hopital Saint-Louis [AP-HP]
29 CANTHER - Hétérogénéité, Plasticité et Résistance aux Thérapies des Cancers = Cancer Heterogeneity, Plasticity and Resistance to Therapies - UMR 9020 - U 1277
2 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
3 CICLY - Centre pour l'innovation en cancérologie de Lyon
4 ICM - UNICANCER - Institut régional du Cancer Montpellier Val d'Aurelle
5 IRCM - U1194 Inserm - UM - Institut de Recherche en Cancérologie de Montpellier
6 MASCOT (UMR_S_942 / U942) - Marqueurs cardiovasculaires en situation de stress
7 Service d'Anesthésie-Réanimation [AP-HP Hôpitaux Saint-Louis Lariboisière]
8 Département de chirurgie viscérale [Gustave Roussy]
9 Service de Chirurgie Digestive [CHU Rouen]
10 Hôpital de Hautepierre [Strasbourg]
11 UNICANCER/ICO - Institut de Cancérologie de l'Ouest [Angers/Nantes]
12 UNICANCER/ICL - Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy]
13 Hôpital Robert Debré
14 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
15 Hôpital Louis Mourier - AP-HP [Colombes]
16 CHU Saint-Antoine [AP-HP]
17 TIMONE - Hôpital de la Timone [CHU - APHM]
18 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
19 Service de Chirurgie Digestive [CHRU Besançon]
20 Institut Curie [Paris]
21 Service Chirurgie Digestive et Hépatobiliaire [CHU Clermont-Ferrand]
22 CHU Amiens-Picardie
23 UNICANCER/Lille - Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille]
24 Hôpital Haut-Lévêque [CHU Bordeaux]
25 UNICANCER/CRLC - Centre Régional de Lutte contre le Cancer François Baclesse [Caen]
26 CHU Limoges
27 ICM - Institut régional de Cancérologie de Montpellier
28 AP-HP - Hopital Saint-Louis [AP-HP]
29 CANTHER - Hétérogénéité, Plasticité et Résistance aux Thérapies des Cancers = Cancer Heterogeneity, Plasticity and Resistance to Therapies - UMR 9020 - U 1277
Olivier Glehen
- Fonction : Auteur
- PersonId : 1359956
- ORCID : 0000-0002-2802-4974
- IdRef : 120001845
Olivia Sgarbura
- Fonction : Auteur
- PersonId : 775312
- ORCID : 0000-0002-6965-3697
Charles Sabbagh
- Fonction : Auteur
- PersonId : 1151816
- ORCID : 0000-0001-7525-0627
- IdRef : 154808261
Marc Pocard
- Fonction : Auteur
- PersonId : 184223
- IdHAL : marc-pocard
- ORCID : 0000-0002-4793-0008
- IdRef : 151541809
Résumé
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.