Evaluating Respiratory Complications Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy With Subphrenic Peritonectomy Versus Full Thickness Diaphragm Resection.

BACKGROUND AND

OBJECTIVES

Patients with diaphragm tumor deposits undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) require subphrenic peritonectomy (SPP) or full-thickness diaphragm resection (FTR) to achieve complete cytoreduction. The incidence and severity of respiratory complications from these techniques are not well characterized. We compared the rate of respiratory complications between SPP and FTR and identified predictive factors.

METHODS

CRS/HIPEC patients between 2013 and 2022 were screened. Those who underwent SPP and FTR were evaluated. The primary endpoint was incidence of respiratory complications. Multivariable logistic regression identified risk factors for respiratory complications.

RESULTS

Among 208 CRS/HIPEC procedures, 100 involved the diaphragm. Respiratory complications occurred in 16/81 (19.8%) of SPP and 6/19 (31.6%) of FTR cases; a difference that was not statistically significant (OR 2.26, 95% CI 0.63-8.11, p = 0.211). All respiratory complications following FTR were classified as major (Clavien-Dindo ≥ 3, p = 0.013). Bilateral diaphragm involvement was associated with increased risk of respiratory complications (OR 12.3, 95% CI 2.62-57.8, p = 0.001), while age, gender, smoking, and PCI score were not.

CONCLUSION

FTR may allow complete cytoreduction in CRS/HIPEC without increased incidence of respiratory morbidity, however FTR is associated with more severe complications. Bilateral diaphragm involvement, regardless of resection type, is predictive of respiratory complications.