Aytaç POLAT, Selçuk GÜLMEZ, Deniz AVAN, A. Serkan SENGER, Orhan UZUN, Mürşit DİNÇER, Nuri HAVAN, Erdal POLAT, Mustafa DUMAN
Turkish Journal of Medical Sciences - 2026;56(5):1556-1564
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 (DeltaLAR) for major complications following CRS/HIPEC. Materials and methods: This retrospective cohort study evaluated 150 consecutive adult patients undergoing CRS/HIPEC. Delta-Lactate was calculated as the difference between arterial lactate levels measured before general anesthesia induction and at the end of surgery. DeltaLAR was calculated by dividing Delta-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 DeltaLAR. 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. Delta-Lactate, postoperative albumin, and DeltaLAR showed significant intergroup differences. A DeltaLAR cutoff of 1.65 demonstrated an area under the ROC curve of 0.831, with 70.0% sensitivity and 85.5% specificity. Patients with DeltaLAR of >=1.65 had a markedly higher incidence of major complications (63.6% vs. 11.3%) and longer hospital stays. In multivariate analysis, DeltaLAR remained an independent predictor of major postoperative complications. Conclusion: DeltaLAR 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.
