Primary and Secondary Outcomes

The primary outcome was the rate of non-therapeutic laparotomies during CRS for cohorts A and B. Secondary outcomes were major postoperative complications, in-hospital mortality, disease-free survival (DFS), and overall survival (OS). Furthermore, to evaluate the implementation of DLS in the preoperative work-up, we calculated the number of patients who did not undergo DLS in our academic center after the introduction of DLS in the preoperative work-up for CRS + HIPEC (e.g. cohort B). Reasons for refraining from DLS were retrospectively explored from digital medical records.

Major postoperative complications are defined as grade 3 or higher according to the Clavien–Dindo classification system, and registered up to 90 days after surgery.24 These types of complications require endoscopic, radiologic, or surgical interventions, or admission to the intensive care unit. Postoperative mortality is defined as death within 30 days after surgery; OS is defined as the time between the initial exploratory laparotomy and death or date of last follow-up in censored cases; and DFS was defined as the time between CRS + HIPEC and the date of first recurrence or last follow-up in censored cases.