Background: In the absence of large randomized trials, the independent contribution of intraperitoneal chemotherapy (IPC) to morbidity and mortality (M+M) from cytoreductive surgery remains uncertain. In a multi-institutional cohort of colorectal surgery patients, we examined the association between M+M and the use of IPC.
Methods: Patients undergoing an open colorectal resection for cancer with and without administration of IPC were identified using the American College of Surgeons National Surgical Quality Improvement Program database (2005-2012). Multivariate logistic regression identified factors associated with 30-day M+M. Using a propensity score matching method, patients undergoing IPC were matched 1:3 to non-IPC patients. M+M within the matched cohort was compared using the χ (2) test.
Results: Of the 33,912 patients identified, 188 had concurrent IPC. The M+M rates were 41 and 30 % with and without IPC, respectively (p = 0.002). In multivariate analysis, IPC was not associated with M+M (odds ratio 0.92; p = 0.62). Using a propensity score match to control for patient and operative factors, patients who received IPC (n = 188) were matched to patients who did not receive IPC (n = 365). The M+M rates in the matched cohort did not significantly differ (41 % with IPC and 45 % without IPC; p = 0.34). Similarly, mortality (1.1 vs. 2.5 %; p = 0.26) and length of stay (12 vs. 11 days; p = 0.27) were not affected by IPC status.
Conclusions: After controlling for patient and operative factors, IPC was not associated with increased M+M following colorectal resection. The high morbidity observed in patients receiving IPC appears to be driven by operative factors other than the use of IPC.