An analysis of the survival impact of dexmedetomidine in children undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

Figures & data

Table 1: Baseline and perioperative characteristics of study population.

Patient characteristics	Dexmedetomidine		p value
	None	Yes		Entire study population
	(n = 60)	(n = 33)		(n = 93)
Age, years	12 ± 5	12 ± 5	0.907	12 ± 5
Mean ± SD	13 (8, 16)	12 (10, 16)		12 (8, 16)
Median (IQR)
Gender [n (%)]	27 (45)	12 (36)	0.419	39 (42) 54 (58)
Female	33 (55)	21 (64)
Male
ASA [n (%)]	8 (13)	1 (3)	0.151	9 (10)
II	52 (87)	32 (97)		84 (90)
III and IV
Diagnosis [n (%)]	3 (5)	1 (3)	0.666	4 (4)
Colorectal	29 (48)	17 (52)		46 (50)
Desmoplastic	2 (3)	1 (3)		3 (3)
Mesothelioma	7 (12)	7 (21)		14 (15)
Rhabdomyosarcoma	19 (32)	7 (21)		26 (28)
Others
Extra-abdominal disease [n (%)]	50 (83)	29 (88)	0.763	79 (85)
No	10 (17)	4 (12)		14 (15)
Yes
Neoadjuvant therapy [n (%)]	1 (2)	1 (3)	1.000	2 (2)
No	59 (98)	32 (97)		91 (98)
Yes
Anesthesia duration, minutes	763 ± 211	810 ± 217	0.390	780 ± 213
Mean ± SD	738 (580, 920)	774 (677, 917)		758 (618, 917)
Median (IQR)
Intraoperative crystalloid, ml/kg	77 ± 46	63 ± 29	0.420	72 ± 41
Mean ± SD	64 (40, 106)	60 (49, 78)		60 (42, 95)
Median (IQR)
Intraoperative colloid, ml/kg	35 ± 22	31 ± 15	0.705	34 ± 20
Mean ± SD	29 (22, 42)	29 (20, 43)		29 (21, 42)
Median (IQR)
Urine output, ml/kg	2.8 ± 1.6	3.2 ± 1.6	0.120	3.0 ± 1.6
Mean ± SD	2.5 (1.7, 3.3)	2.7 (2.0, 4.2)		2.6 (1.9, 3.6)
Median (IQR)
Tumor burden, PCI	17 ± 10	21 ± 11	0.213	18 ± 10
Mean ± SD	15 (9, 24)	23 (11, 31)		15 (10, 25)
Median (IQR)
Completeness of cytoreduction			1.000
[n (%)]
No
Yes	7 (12)	4 (12)		11 (12)
	50 (88)	28 (88)		78 (88)
Intraoperative opioid, MED/kg	0.8 ± 0.9	0.7 ± 0.7	0.487	0.8 ± 0.8
Mean ± SD	0.6 (0.3, 1.0)	0.5 (0.3, 0.8)		0.6 (0.3, 0.9)
Median (IQR)
Estimated blood loss, ml/kg	18 ± 30	15 ± 18	0.619	17 ± 26
Mean ± SD	7 (3, 15)	7 (4, 17)		7 (3, 16)
Median (IQR)
Perioperative blood transfusion [n (%)]	15 (25)	4 (12)	0.183	19 (20)
No	45 (75)	29 (88)		74 (80)
Yes
Length of stay, days	13 ± 7	13 ± 5	0.732	13 ± 6
Mean ± SD	12 (8, 16)	12 (9, 16)		12 (9, 16)
Median (IQR)

SD: Standard deviation; IQR: Interquartile range; ASA: American Society of Anesthesiologists physical status score; PCI: Peritoneal Carcinomatosis Index score; MED: Morphine equivalent dose.

n [%] = number of patients [percentage of patients in sub-group].

Figure 1: Kaplan–Meier curves showing the recurrence free survival of patients who received dexmedetomidine (Yes) and those who did not (No).

Table 2: Univariate and multivariable cox proportional hazard models for progression free survival.

Study covariates	Univariate analysis			Multivariate analysis
	HR	95%CI	p value	HR	95%CI	p value
Age	0.96	0.90–1.02	.199
Tumor burden (PCI)	1.03	0.10–1.07	.062
Extra-abdominal disease	3.03	1.38–6.65	.006	2.40	1.03–5.59	.043
Anesthesia duration	1.00	1.00–1.00	.024	1.001	1.00–1.00	.210
Incomplete cytoreduction	2.94	1.28–6.73	.011	2.49	1.04–6.00	.042
Intraoperative opioid consumption (MED)	1.29	0.90–1.84	.165
Intraoperative crystalloid	1.01	1.00–1.02	.005
Intraoperative colloid	1.00	0.99–1.02	.651
Dexmedetomidine	1.30	0.66–2.57	.450	1.20	0.60–2.41	.606
Estimated blood loss	1.00	1.00–1.01	.302

PCI: PeritoneStaal Carcinomatosis Index; MED: Morphine equivalent dose.

Figure 2: Kaplan–Meier curves showing the overall survival of patients who received dexmedetomidine (Yes) and those who did not (No).

Table 3: Univariate and multivariable cox proportional hazard models for overall survival.

Study covariates	Univariate analysis			Multivariate analysis
	HR	95%CI	p value	HR	95%CI	p value
Age	0.97	0.91–1.04	.354
Tumor burden (PCI)	1.06	1.01–1.10	.016
Extra-abdominal disease	2.60	1.14–5.93	.024	2.12	0.88–5.15	.096
Anesthesia duration	1.00	1.000–1.003	.079	1.00	0.99–1.00	.559
Incomplete cytoreduction	3.94	1.64–9.48	.002	3.46	1.31–9.16	.013
Intraoperative opioid consumption (MED)	1.62	1.12–2.35	.011
Intraoperative crystalloid	1.01	1.00–1.01	.026
Intraoperative colloid	1.00	0.99–1.02	.666
Dexmedetomidine	1.05	0.47–2.33	.905	0.81	0.35–1.85	.611
Estimated blood loss	1.00	0.99–1.01	.308

PCI: Peritoneal Carcinomatosis Index; MED: Morphine equivalent dose.