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Turkish Journal of Medical Sciences

Abstract

Background/aim: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) imposes substantial physiological stress and carries a high risk of major postoperative complications. This study aimed to evaluate the predictive value of the delta lactate-to-albumin ratio (ΔLAR) for major complications following CRS/HIPEC.

Materials and methods: This retrospective cohort study evaluated 150 consecutive adult patients undergoing CRS/HIPEC. Δ-Lactate was calculated as the difference between arterial lactate levels measured before general anesthesia induction and at the end of surgery. ΔLAR was calculated by dividing Δ-lactate by serum albumin measured at 6–9 h postoperatively. Major postoperative complications were defined as Clavien–Dindo grade ≥III complications within 30 days. Receiver operating characteristic (ROC) curve analysis and multivariate logistic regression were performed to evaluate the predictive performance of ΔLAR.

Results: Major postoperative complications occurred in 40 patients (26.7%). Operative duration and Peritoneal Cancer Index scores were significantly higher in patients with major complications. Δ-Lactate, postoperative albumin, and ΔLAR showed significant intergroup differences. A ΔLAR cutoff of 1.65 demonstrated an area under the ROC curve of 0.831, with 70.0% sensitivity and 85.5% specificity. Patients with ΔLAR of ≥1.65 had a markedly higher incidence of major complications (63.6% vs. 11.3%) and longer hospital stays. In multivariate analysis, ΔLAR remained an independent predictor of major postoperative complications.

Conclusion: ΔLAR is a simple, readily available, and robust composite marker with potential for predicting major postoperative complications after CRS/HIPEC. A cutoff value of ≥1.65 may allow clinicians to identify high-risk patients early in the postoperative course, supporting more targeted monitoring and timely intervention. Larger prospective multicenter studies are needed to confirm these findings and establish their clinical applicability.

Author ORCID Identifier

AYTAÇ POLAT: 0000-0002-0268-1036

SELCUKSELÇUK GULMEZGÜLMEZ: 0000-0001-9719-1904

DENİZ AVAN: 0000-0002-1650-7522

AZİZ SENGER: 0000-0003-0981-0141

ORHAN UZUN: 0000-0001-6550-0936

MURSİTMÜRŞİT DİNCERDİNÇER: 0000-0002-1930-0383

NURİ HAVAN: 0000-0003-1462-5012

ERDAL POLAT: 0000-0002-9463-9846

MUSTAFA DUMAN: 0000-0002-0276-0543

DOI

10.55730/1300-0144.6401

Keywords

Albumin, lactic acid, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy, lactate/albumin ratio, morbidity

First Page

1556

Last Page

1564

Publisher

The Scientific and Technological Research Council of Türkiye (TÜBİTAK)

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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