Palliative Gastrointestinal Surgery in Patients With Advanced Peritoneal Carcinomatosis: Clinical Experience and Development of a Predictive Model for Surgical Outcomes

Jolene Si Min Wong; Sze Min Lek; Daniel Yan Zheng Lim; Claramae Shulyn Chia; Grace Hwei Ching Tan; Chin-Ann Johnny Ong; Melissa Ching Ching Teo

doi:10.3389/fonc.2021.811743

Palliative Gastrointestinal Surgery in Patients With Advanced Peritoneal Carcinomatosis: Clinical Experience and Development of a Predictive Model for Surgical Outcomes

Front Oncol. 2022 Jan 13:11:811743. doi: 10.3389/fonc.2021.811743. eCollection 2021.

Authors

Jolene Si Min Wong^{1

2

3

4}, Sze Min Lek⁵, Daniel Yan Zheng Lim⁶, Claramae Shulyn Chia^{1

2

3

4}, Grace Hwei Ching Tan^{1

2}, Chin-Ann Johnny Ong^{1

2

3

4

7

8}, Melissa Ching Ching Teo^{1

2

3

4}

Affiliations

¹ Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
² Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore.
³ SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
⁴ SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
⁵ Department of Anaesthesia and Surgical Intensive Care, Changi General Hospital, Singapore, Singapore.
⁶ Health Services Research Unit, Medical Board, Singapore General Hospital, Singapore, Singapore.
⁷ Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore.
⁸ Institute of Molecular and Cell Biology, ASTAR Research Entities, Singapore, Singapore.

Abstract

Background: Palliative gastrointestinal (GI) surgery potentially relieves distressing symptoms arising from intestinal obstruction (IO) in patients with advanced peritoneal carcinomatosis (PC). As surgery is associated with significant morbidity risks in advanced cancer patients, it is important for surgeons to select patients who can benefit the most from this approach. Hence, we aim to determine predictors of morbidity and mortality after palliative surgery in patients with PC. In addition, we evaluate the utility of the UC Davis Cancer Care nomogram (UCDCCn) and develop a simplified model to predict short-term surgical mortality in these patients.

Methods: A retrospective review of patients with IO secondary to PC undergoing palliative GI surgery was performed. Logistic regression was used to determine independent predictors of 30-day morbidity and mortality after surgery. UCDCCn was evaluated using the area under the curve (AUC) for discriminatory power and the Hosmer-Lemeshow test for calibration. Our simplified model was developed using logistic regression and evaluated using cross-validation.

Results: A total of 254 palliative GI surgeries were performed over a 10-year duration. The 30-day morbidity and mortality were 43% (n = 110) and 21% (n = 53), respectively. Preoperative albumin, age, and emergency nature of surgery were significant independent predictors for 30-day morbidity. A simplified model using preoperative Eastern Cooperative Oncology Group (ECOG) status and albumin (AUC = 0.71) achieved better predictive power than UCDCCn (AUC = 0.66) for 30-day mortality.

Conclusion: Good ECOG status and high preoperative albumin levels were independently associated with good short-term outcomes after palliative GI surgery. Our simplified model may be used to conveniently and efficiently select patients who stand to benefit the most from surgery.

Keywords: advanced cancer; intestinal obstruction; palliation; palliative surgery; peritoneal carcinomatosis.