ORIGINAL RESEARCH article
Front. Surg.
Sec. Visceral Surgery
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1664710
Intensive care scores predict outcomes in patients receiving cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)
Provisionally accepted
Julia Wimmer1*
Miklos Acs2
Gyula Bohus3Patricia Hauer2Veronika Müller2Niklas Bogovic2Paul Kupke2Przemyslaw Slowik2
Hans Jürgen Schlitt2
Matthias Hornung2
Jens M. Werner2- 1Department of Anaesthesiology, Universitatsklinikum Regensburg, Regensburg, Germany
- 2Department of Surgery, Universitatsklinikum Regensburg, Regensburg, Germany
- 3Faculty of Medicine, Semmelweis Egyetem, Budapest, Hungary
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Surgical management of patients with peritoneal surface malignancies (PSM) via multivisceral resection is associated with increased morbidity and mortality in the immediate postoperative period, rendering intensive care therapy critically important. We aimed to determine whether intensive care unit (ICU) course and scoring systems predict not only short-term but also long-term outcomes. We retrospectively analyzed the medical records of all patients who underwent cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal surface malignancies (PSM) between 2008 and 2015 at a university cancer center. Upon postoperative ICU admission, Simplified Acute Physiology Score (SAPS II) and Sequential Organ Failure Assessment (SOFA) scores were recorded. Complications during the ICU stay and overall hospitalization were documented, and patients were followed according to a standardized protocol after discharge. A total of 251 patients were included. The mean Peritoneal Cancer Index (PCI) was 14 ± 9.1 and correlated significantly with both ICU stay duration (p = 0.002) and total hospital stay (p = 0.001). In-hospital mortality was 2%, and the reoperation rate was 16.7%. SOFA scores on the day of surgery, postoperative days 1, 2, and 7 demonstrated strong correlations with ICU length of stay (all p ≤ 0.001) and with overall hospital stay (p = 0.001 for the day of surgery and day 7; p ≤ 0.001 for days 1 and 2). In multivariate analysis, SOFA score on postoperative day 7 (hazard ratio [HR] 1.261; 95% confidence interval [CI] 1.120–1.421; p ≤ 0.001) and SAPS II on the day of surgery (HR 1.042; 95% CI 1.017–1.068; p ≤ 0.001) emerged as independent predictors of overall survival. In conclusion, SAPS II and SOFA scores not only predict ICU and hospital lengths of stay but also independently forecast overall survival in patients undergoing CRS and HIPEC for PSM.
Keywords: Cytoreductive surgery, HIPEC, Intensive Care Unit, Long term outcome, saps, SOFA
Received: 12 Jul 2025; Accepted: 29 Sep 2025.
Copyright: © 2025 Wimmer, Acs, Bohus, Hauer, Müller, Bogovic, Kupke, Slowik, Schlitt, Hornung and Werner. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Julia Wimmer, julia1.wimmer@klinik.uni-regensburg.de
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