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Trends in the indications for and short-term outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

Published on Sep 19, 2019in American Journal of Surgery2.201
· DOI :10.1016/j.amjsurg.2019.09.017
Eliza W. Beal10
Estimated H-index: 10
(The Ohio State University Wexner Medical Center),
Ahmed Ahmed1
Estimated H-index: 1
(The Ohio State University Wexner Medical Center)
+ 24 AuthorsJordan M. Cloyd9
Estimated H-index: 9
(The Ohio State University Wexner Medical Center)
Abstract
Abstract Background Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is an increasingly utilized strategy for patients with peritoneal surface malignancies (PSM). Methods The US HIPEC Collaborative was retrospectively reviewed to compare the indications and perioperative outcomes of patients who underwent CRS ± HIPEC between 2000 and 2012 (P1) versus 2013–2017 (P2). Results Among 2,364 patients, 39% were from P1 and 61% from P2. The most common primary site was appendiceal (64%) while the median PCI was 13 and most patients had CCR 0 (60%) or 1 (25%). Over time, median estimated blood loss, need for transfusion, and length of hospital stay decreased. While the incidence of any (55% vs. 57%; p = 0.426) and Clavien III/IV complications did not change over time, there was a decrease in 90-day mortality (5% vs. 3%; p = 0.045). Conclusion CRS-HIPEC is increasingly performed for PSM at high-volume centers. Despite improvements in some perioperative outcomes and a reduction in postoperative mortality, morbidity rates remain high.
  • References (10)
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References10
Newest
#1U. O. Gustafsson (KI: Karolinska Institutet)H-Index: 8
#2Michael J. Scott (UPenn: University of Pennsylvania)H-Index: 2
Last. Olle Ljungqvist (KI: Karolinska Institutet)H-Index: 69
view all 25 authors...
Background This is the fourth updated Enhanced Recovery After Surgery (ERAS®) Society guideline presenting a consensus for optimal perioperative care in colorectal surgery and providing graded recommendations for each ERAS item within the ERAS® protocol.
46 CitationsSource
#1Faiz Gani (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 17
#2Alison Conca-Cheng (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 2
Last. Fabian M. Johnston (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 12
view all 5 authors...
2 CitationsSource
#1Anghela Z. Paredes (The Ohio State University Wexner Medical Center)H-Index: 4
#2Sherif Abdel-Misih (The Ohio State University Wexner Medical Center)H-Index: 9
Last. Jordan M. Cloyd (The Ohio State University Wexner Medical Center)H-Index: 9
view all 6 authors...
Abstract Background Risk factors for hospital readmission after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are poorly understood. Methods The American College of Surgeons–National Surgical Quality Improvement Program databases from 2011 to 2016 were used to identify all patients who underwent CRS-HIPEC. Demographic, clinical, and perioperative variables were examined using logistic regression to identify factors associated with 30-d postoperative readmissio...
2 CitationsSource
#1Lieselotte Lemoine (University of Hasselt)H-Index: 3
#2Paul H. Sugarbaker (Washington Cancer Institute)H-Index: 83
Last. Kurt Van der Speeten (University of Hasselt)H-Index: 12
view all 3 authors...
AbstractPeritoneal surface malignancy (PSM) is a common manifestation of digestive and gynaecologic malignancies alike. At present, patients with isolated PSM are treated with a combination therapy of cytoreductive surgery (CRS) and hyperthermic peroperative intraperitoneal chemotherapy (HIPEC). The combination of CRS and intraperitoneal (IP) chemotherapy should now be considered standard of care for PSM from appendiceal epithelial cancers, colorectal cancer and peritoneal mesothelioma. Although...
6 CitationsSource
#2Gregory B. RussellH-Index: 38
Last. Edward A. Levine (Wake Forest Baptist Medical Center)H-Index: 54
view all 6 authors...
Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have shown variability in survival outcomes when used to treat peritoneal surface disease (PSD) from appendiceal and colorectal cancers. The primary goal of this study was to examine outcomes for high-grade appendiceal (HGA) and high-grade colonic primaries after CRS-HIPEC to determine if a significant difference exists between the two groups. Methods: A retrospective analysis of patients with peritonea...
8 CitationsSource
#1Konstantinos I. Votanopoulos (Wake Forest Baptist Medical Center)H-Index: 21
#2Greg Russell (Wake Forest Baptist Medical Center)H-Index: 24
Last. Edward A. Levine (Wake Forest Baptist Medical Center)H-Index: 54
view all 6 authors...
Background Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) used to treat peritoneal surface disease (PSD) from appendiceal cancer have shown variability in survival outcomes. The primary goal of this study was to determine predictors of surgical morbidity and overall survival. The secondary goal was to describe the impact of nodal status on survival after CRS/HIPEC for PSD from low-grade appendiceal (LGA) and high-grade appendiceal (HGA) primary lesions.
27 CitationsSource
#1Konstantinos I. Votanopoulos (Wake Forest University)H-Index: 21
#2Naeem A. Newman (Wake Forest University)H-Index: 3
Last. Edward A. Levine (Wake Forest University)H-Index: 54
view all 7 authors...
Background Cytoreductive surgery (CRS)/Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is associated with prolonged survival in selected patients with peritoneal surface disease. Yet, for elderly patients (older than 70 years of age) CRS/HIPEC is controversial, due to associated morbidity.
52 CitationsSource
#1U. O. Gustafsson (KI: Karolinska Institutet)H-Index: 8
#2Michael J. Scott (University of Surrey)H-Index: 15
Last. Olle Ljungqvist (Örebro University)H-Index: 69
view all 15 authors...
Background This review aims to present a consensus for optimal perioperative care in colonic surgery and to provide graded recommendations for items for an evidenced-based enhanced perioperative protocol.
634 CitationsSource
#1Y.L.B. KlaverH-Index: 11
#2Lieke H. J. Simkens (Radboud University Nijmegen Medical Centre)H-Index: 10
Last. Cornelis J. A. Punt (UvA: University of Amsterdam)H-Index: 73
view all 8 authors...
Abstract Background Although systemic therapies have shown to result in survival benefit in patients with metastatic colorectal cancer (mCRC), outcomes in patients with peritoneal carcinomatosis (PC) are poor. No data are available on outcomes of current chemotherapy schedules plus targeted agents in mCRC patients with PC. Methods Previously untreated mCRC patients treated with chemotherapy in the CAIRO study and with chemotherapy and targeted therapy in the CAIRO2 study were included and retros...
99 CitationsSource
#1Hatem El Halabi (Mercy Medical Center (Baltimore, Maryland))H-Index: 3
#2Vadim Gushchin (Mercy Medical Center (Baltimore, Maryland))H-Index: 14
Last. Armando Sardi (Mercy Medical Center (Baltimore, Maryland))H-Index: 25
view all 8 authors...
Background Patients with peritoneal mucinous carcinomatosis (PMCA) of appendiceal origin and extensive disease are commonly advised against CRS/HIPEC. We hypothesize that CRS/HIPEC is a beneficial treatment for this group.
52 CitationsSource
Cited By0
Newest
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#1JC Chen (The Ohio State University Wexner Medical Center)
#2Eliza W. Beal (The Ohio State University Wexner Medical Center)H-Index: 10
Last. Jordan M. Cloyd (The Ohio State University Wexner Medical Center)H-Index: 9
view all 6 authors...
BACKGROUND: Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) is indicated for patients with peritoneal dissemination of appendiceal cancer. The role of neoadjuvant chemotherapy (NAC) before CRS-HIPEC remains controversial. METHODS: A retrospective review of adult patients who underwent CRS +/- HIPEC for metastatic appendiceal cancer between 2000-2017 was performed. Patients who received NAC followed by surgery were compared with those who underwent su...
Source
#1Benjamin D. PowersH-Index: 5
#2Seth FelderH-Index: 1
Last. Vikrom K. Dhar (University of Cincinnati Academic Health Center)H-Index: 6
view all 27 authors...
BACKGROUND: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is offered to select patients with peritoneal metastases. In instances of recurrence/progression, a repeat CRS/HIPEC may be considered. The perioperative morbidity and the potential oncologic benefits are not well described. PATIENTS AND METHODS: We performed a retrospective analysis of a multiinstitutional database to assess the perioperative outcomes following repeat CRS/HIPEC (repeat). Kaplan-Meier and...
1 CitationsSource