Factors Predicting Learning Curve, Morbidity, Mortality, and Outcomes: A Prospective Phase III Study of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Peritoneal Surface Malignancy-First Indian Study.

e17512 Background: The risk of morbidity associated with CRS & HIPEC is substantial enough to make any surgeon think twice before adopting it. Knowing the factors that will predict morbidity would help us in deciding which patients to push forward for HIPEC after CRS.This study is an attempt to find such factors that predict morbidity. Methods: Patients diagnosed of peritoneal surface malignancy from ovary, colorectal, appendicular, stomach, mesothelioma and other rare variety were included in the study. The study period was from March 2012 to December 2017. After cytoreductive surgery HIPEC was done with Performer HT (RanD) machine. All data prospectively entered in the HIPEC registry was analyzed with main focus on morbidity and factors predicting morbidity . Results: Of the 163 cases, primary organ of origin were ovary, colorectal, stomach, mesothelioma and others ( 110,27,8,14,4) respectively. 20 were upfront, 94 interval and 49 recurrent cases. Mean duration of surgery was 9.5hours, blood loss 1250ml and PCI 17. Total , upper quadrant , pelvic, peritonectomy, glissons capsulectomy, mesenteric stripping was done in 42.5%,68.1%,69.3%,14.7% & 4.3% respectively. Multivisceral ,diaphragmatic & bowel resection was done in 20.9%,40.5% and 57.5%. More than one anastomosis was done in 13.4%. 44.7%were extubated on table, 14.7%required prolonged ventilation, mean ICU stay 2.5 days. G3-G5 morbidity was noted in 40%, major being surgical 30%, hematological 20%, electrolyte imbalance 19%. Performance status, mean PCI > 14, duration of surgery > 10 hours, multivisceral resection, total peritonectomy, upper quadrant peritonectomy , more than one anastomosis were found to be significant factors predicting morbidity. The learning curve to reach technical proficiency in CRS + HIPEC is about 60 cases for a center with high volume cases . Conclusions: Analysing our journey of CRS & HIPEC we would want to tell that doing HIPEC for patients with above mentioned risk factors would be double edged sword and so one should weigh the benefits against morbidity when considering such patients for CRS & HIPEC.