Preoperative nutritional risk assessment in patients undergoing cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for colorectal carcinomatosis

Figures & data

Figure 1. Measurement of body composition parameters using axial CT slice at the level of the third lumbar vertebra. (a) Delineation of total muscle area (pink), using a threshold of −29 to +150 HU. (b) Delineation of visceral (green) and (c) subcutaneous (blue) fat areas, using a threshold of −190 to −30 HU.

Table 1. Baseline demographic and disease characteristics of the 214 patients.

Items	Value, n (%)
Age (years)
Median (range)	59.5 (24–78)
>70 years	20 (9)
Gender
Male	105 (49)
Female	109 (51)
Period
2009–2011	69 (32)
2012–2014	145 (68)
Primary location
Right colon	78 (36)
Left colon	133 (62)
Neoadjuvant chemotherapy
Yes/No	203/11 (95/5)
Median (range)	8 (2-46)
>6 cycles	104 (49)
Bevacizumab	96 (45)
Second line	97 (45)
Charlson score
Median (range)	8 (2–11)
PCI score
Median (range)	7 (0–27)
>15	39 (18)
Duration of surgery (min)
Median (range)	270 (90–540)
>270 min	64 (30)
CC-score
0	202 (94)
1	12 (6)
HIPEC
Yes/no	158/56 (74/26)
Hospital stay (days)
Median (range)	20 (7–91)

PCI: peritoneal cancer index; CC: completeness of cytoreduction; HIPEC: hyperthermic intraperitoneal chemotherapy.

Missing data: three for primary location, length of surgery.

Figure 2. Overall survival curves regarding albumin rate.

Table 2. Outcomes after cytoreductive surgery separated by nutritional factors in univariate analysis.

	Median (in months)	p value*
Overall survival
Body mass index (kg/m^2)
<35	59	0.516
≥35	50
Albumin level (g/L)
≥35	59	0.015
<35	23
Sarcopenia
Yes	59	0.648
No	50
Visceral fat (cm^2)
<99.2	59	0.822
≥99.2	41
Subcutaneous fat (cm^2)
<198	74	0.538
≥198	41
Progression free survival
Body mass index (kg/m^2)
<35	12.8	0.801
>35	14
Albumin level (g/L)
≥35	13	0.362
<35	10
Sarcopenia
Yes	14	0.364
No	12
Visceral fat (cm^2)
<99.2	13	0.467
≥99.2	13
Subcutaneous fat (cm^2)
<198	13	0.888
≥198	13

* Compared using log-rank test.

Table 3. Univariate and multivariate analyses of overall survival after cytoreductive surgery for colorectal peritoneal metastasis.

	Overall survival
	Univariate	Multivariate^a
			95% CI
Risk factor	p	Odds ratio	Lower	Upper	p
Hypoalbuminemia (<35g/L)	0.033	0.562	0.184	0.949	0.037
Male	0.604	NA
Age >70	0.821	NA
PCI >15	0.007	0.562	0.256	1.231	0.540
Major complication	0.005	0.465	0.258	0.838	0.011
Length of surgery >270 min	0.029	0.830	0.433	1.590	0.575
CC-score 0	0.066	0.562	0.256	1.234	0.150

^a Cox regression with enter method with 0.1 selection.

NA: variable non appropriate for multivariate analysis for a p values >0.1.

Table 4. Comparison of patients, with or without major complication, after cytoreductive surgery for peritoneal carcinomatosis separated by nutritional factor, n (%).

Characteristic	All patients, (n = 214)	No complication (n = 106)	Major complication (n = 108)	p value
Body mass index (kg/m^2), median (range)	24.6 (15–42)	24.6 (15–37)	24.6 (16–42)	0.712
≥35 kg/m^2	14 (6.5)	9 (8.5)	5 (5)	0.253
Albumin level (g/L), median (range)	40.8 (19–52)	41.8 (24–52)	40.4 (19–51)	0.180
<35 g/L	19 (9)	9 (8.5)	10 (9)	0.845
Prealbumin level (mg/L), median (range)	0.28 (0.06–0.46)	0.29 (0.10–0.45)	0.27 (0.06–0.46)	0.538
<0.20 mg/L	2 (1)	0	2 (2)	0.160
Sarcopenia	90 (42)	45 (42.5)	45 (42)	0.907
Visceral fat (cm^2), median (range)	99.2 (6.5–332.5)	92 (11.9–313.4)	109.5 (6.5–332)	0.980
≥99.2		52 (49)	55 (51)	0.785
Subcutaneous fat (cm^2), median (range)	198 (45–505)	198 (45–505)	197 (45–442)	0.952
≥198		50 (47)	48 (44)	0.775

Missing data: 16 for albumin, 28 for prealbumin, 18 for subcutaneous fat (part of the subcutaneous fat was out of the field of view), 1 for visceral fat (vertebral metallic artefact at L3 level).