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Grillo-Marín C, Antón-Rodríguez C, Prieto L, Ortega-Pérez G, González-Moreno S. Nephrotoxicity Associated with Cytoreductive Surgery Combined with Cisplatin-Based Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Malignant Disease: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:3793. [PMID: 38999359 PMCID: PMC11242517 DOI: 10.3390/jcm13133793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/14/2024] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Cisplatin is employed in hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery (CRS) for peritoneal surface malignancies (PSMs). The main concern regarding intraperitoneal cisplatin administration is nephrotoxicity. Numerous reports in this context are available. Our objective was to conduct a systematic review and meta-analysis to assess cisplatin-based HIPEC-related nephrotoxicity (CHRN). Methods: A systematic literature review on CHRN after CRS for the treatment of PSMs was performed. The literature search was carried out using Medline, Cochrane, and Embase. The last day of the search was 23 October 2023. PRISMA guidelines were used. A meta-analysis was then conducted. The main endpoint was the incidence of acute and chronic renal impairment after CHRN. Secondary endpoints included the potential impact of several clinical variables on the primary endpoint and a critical appraisal of the different renal impairment scales employed. Results: Our study included 26 articles with a total sample of 1473 patients. The incidence of acute kidney injury (AKI) was 18.6% (95% CI: 13.6-25%, range of true effects 3-59%). For chronic kidney disease, it was 7% (95% CI: 3-15.3%, range of true effects 1-53%). The variables that statistically influenced these results were the scale used to measure renal insufficiency, the use of nephroprotective agents, and the presence of pre-existing renal disease. Conclusions: The reported incidence of renal impairment following cisplatin-based HIPEC is highly variable. The incidence of renal failure obtained in this meta-analysis should be used as a reference for subsequent reports on this topic. Further prospective studies are warranted to establish optimal and standardized management.
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Affiliation(s)
- Cristián Grillo-Marín
- Department of General Surgery, Hospital Universitario Puerta de Hierro, Calle Joaquín Rodrigo 1, 28222 Majadahonda, Spain;
- Unidad de Apoyo a la Investigación, Facultad de Medicina, Universidad Francisco de Vitoria M-515, km 1, 800, 28223 Pozuelo de Alarcón, Spain; (C.A.-R.); (L.P.)
- MD Anderson Cancer Center, Madrid Spain Foundation, Calle Arturo Soria 270, 28033 Madrid, Spain
| | - Cristina Antón-Rodríguez
- Unidad de Apoyo a la Investigación, Facultad de Medicina, Universidad Francisco de Vitoria M-515, km 1, 800, 28223 Pozuelo de Alarcón, Spain; (C.A.-R.); (L.P.)
| | - Lola Prieto
- Unidad de Apoyo a la Investigación, Facultad de Medicina, Universidad Francisco de Vitoria M-515, km 1, 800, 28223 Pozuelo de Alarcón, Spain; (C.A.-R.); (L.P.)
| | - Gloria Ortega-Pérez
- Department of Surgical Oncology, Peritoneal Surface Oncology Program, MD Anderson Cancer Center, Calle Arturo Soria 270, 28033 Madrid, Spain;
| | - Santiago González-Moreno
- Department of Surgical Oncology, Peritoneal Surface Oncology Program, MD Anderson Cancer Center, Calle Arturo Soria 270, 28033 Madrid, Spain;
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Ezanno AC, Chkair S, Quesada JL, Abba J, Malgras B, Trilling B, Sage PY, Bouvet S, Foote A, Aime A, Glehen O, Pocard M, Arvieux C, Tidadini F. Oncological outcomes and hospitalization cost of hyperthermic intraperitoneal chemotherapy (HIPEC) open and closed abdomen techniques: Results from two French expert centers. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107931. [PMID: 38181533 DOI: 10.1016/j.ejso.2023.107931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/07/2023] [Accepted: 12/19/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Hyperthermic intraperitoneal chemotherapy (HIPEC) associated with CC0 excision is performed using either an open (OPEN_HIPEC) or closed abdominal technique (CLOSED_HIPEC). However, little data is available on the costs of this treatment, as there is no code for HIPEC in the French Classification of Medical Acts. Oncological outcomes and the mean cost of hospitalization were compared. METHODS Between 2017 and 2021, 144 patients with peritoneal carcinomatosis (all etiologies) were included (OPEN_HIPEC, n = 70; CLOSED_HIPEC, n = 74) in this retrospective two-center study. Morbi-mortality, overall survival (OS), recurrence-free-survival (RFS) and mean cost of hospitalization were compared. RESULTS The median OS and RFS were 71.3 months [63-71.5] and 26.8 months [20-35.3] respectively, and were similar for both techniques; and after stratification by histology. Multivariate analysis adjusted on PCI score of OS identified mitomycin as a protective factor (HR = 0.31 [0.10-0.90], p = 0.032) and ASA score>2 (HR = 2.32 [1.32- 4.06], p = 0.003) and number of resection (HR = 1.21 [1.06-1.39], p = 0.006) as a risk factors of RFS. Complication rates at day 30 were similar between OPEN and CLOSED_HIPEC, 31 (44.3 %) vs 42 (56.8 %); p = 0.135. OPEN_HIPEC had more severe complications (11 (35.5 %) vs 6 (14.3 %); p = 0.034). The mean cost of hospitalization was estimated as €15,627 for OPEN_HIPEC and €14,211 for CLOSED_HIPEC for a mean length-of-stay of 12.7 and 16.7 days respectively. The mean amount received by the hospital per hospitalization was estimated at €16,399 and €15,536 respectively. CONCLUSIONS OS and RFS were similar for open and closed HIPEC. Severe complications at day 30 were more frequent in OPEN_HIPEC group. The amount received by hospital for both HIPEC techniques is sufficient.
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Affiliation(s)
- Anne-Cécile Ezanno
- Department of Digestive Surgery, Begin Military Teaching Hospital, Saint Mandé, France.
| | - Sihame Chkair
- Department of Biostatistics, Clinical Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, Univ Montpellier, Nîmes, France; IDESP, UMR-INSERM, Montpellier, France
| | - Jean-Louis Quesada
- Clinical Pharmacology Unit, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France
| | - Julio Abba
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Brice Malgras
- Department of Digestive Surgery, Begin Military Teaching Hospital, Saint Mandé, France; French Military Health Service Academy, Ecole du Val de Grâce, Paris, France
| | - Bertrand Trilling
- Univ. Grenoble Alpes, CNRS, CHU Grenoble Alpes, Department of digestive Surgery, Grenoble INP, TIMC, 38000, Grenoble, France
| | - Pierre-Yves Sage
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Sophie Bouvet
- Department of Biostatistics, Clinical Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Alison Foote
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Adeline Aime
- Department of Digestive Surgery, Begin Military Teaching Hospital, Saint Mandé, France
| | - Olivier Glehen
- Lyon Center for Innovation in Cancer, EA 3738, Lyon 1 University, Lyon, France
| | - Marc Pocard
- Department of Digestive Surgery, La Pitié Salpêtrière Hospital, Paris, France, INSERM, U965 CART Unit, Paris, France
| | - Catherine Arvieux
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France; Lyon Center for Innovation in Cancer, EA 3738, Lyon 1 University, Lyon, France
| | - Fatah Tidadini
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France; Lyon Center for Innovation in Cancer, EA 3738, Lyon 1 University, Lyon, France.
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García-Fadrique A, Estevan Estevan R, Sabater Ortí L. Quality Standards for Surgery of Colorectal Peritoneal Metastasis After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 2021; 29:188-202. [PMID: 34435297 DOI: 10.1245/s10434-021-10642-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/27/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The standardization of surgical outcomes throughout surgical procedures is mandatory. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) should provide proficient oncological and surgical outcomes. STUDY DESIGN The aim of this study was to identify clinically relevant quality indicators and their quality standard, and to determine their acceptable quality limit. A systematic review on cytoreductive results from 2000 to 2018 was performed focusing on clinical guidelines, consensus conferences, and publications. After the selection of quality indicators, a systematic review of indexed references was performed in order to calculate the quality standard for each indicator. STUDY SELECTION Unicentric/multicentric series, comparative studies, and clinical trials. Studies were to include outcomes after cytoreduction of colorectal origin and series with more than 50 patients. Quality indicators with at least 10 series were mandatory and objective measurements were also mandatory for inclusion. MAIN OUTCOME MEASUREMENTS Quality indicators selected were 1- to 5-year survival, overall disease-free survival, 1- to 5-year disease-free survival, complete surgical resection, duration of surgery, length of stay, overall morbimortality, major morbidity, re-intervention, postoperative hemorrhage, intestinal fistula, anastomotic leakage, wound infection, postoperative medical complications, overall recurrence, and failure to rescue. RESULTS The most relevant quality indicators and critical quality limits were overall disease-free survival and 5-year overall disease-free survival (14 months and <10 months, and 14% and <4%, respectively), completeness of surgical resection (89% and <80%, respectively), overall mortality (3% and >8%, respectively), overall morbidity (47% and >63%, respectively), failure to rescue (12% and <30%, respectively), reintervention (13 and <22%, respectively), anastomotic leakage (6% and <13%, respectively), and overall recurrence (60% and <74%, respectively). CONCLUSION This is the first study to assess quality standards in CRS + HIPEC for colorectal peritoneal metastases. The current data are of particular relevance for future studies to control the variability of this surgery.
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Affiliation(s)
| | | | - Luis Sabater Ortí
- Hospital Clínico Universitario, Department of Surgery, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
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The addition of sodium thiosulphate to hyperthermic intraperitoneal chemotherapy with cisplatin in ovarian cancer. Gynecol Oncol Rep 2021; 37:100796. [PMID: 34141848 PMCID: PMC8185237 DOI: 10.1016/j.gore.2021.100796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 12/28/2022] Open
Abstract
Cisplatin chemotherapy is highly nephrotoxic and is a dose limiting side effect. The OVIHIPEC-1 trial employed sodium thiosulphate (ST) as a renal protectant. We analyse the implementation of HIPEC for EOC in a peritoneal malignancy centre. One acute kidney injury (AKI) event was noted when ST was not used with HIPEC. No AKI was observed when sodium thiosulphate was used with cisplatin at 100 mg/m2.
Cisplatin based hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to prolong recurrence free and overall survival of women with ovarian cancer who have responded to neoadjuvant chemotherapy. The aim of this study was to assess the impact of cytoreductive surgery with or without the addition of HIPEC on renal function. Method This is a retrospective case-controlled study at a tertiary teaching hospital in Dublin, Ireland. All patients who had interval cytoreductive surgery (CRS) and HIPEC from October 2017 to October 2020 were included. A cohort of patients who had interval CRS without HIPEC were included as a control. Sodium thiosulphate (ST) was added to the HIPEC protocol in 2019. In order to assess the impact of ST as a renal protectant, renal function and post-operative outcomes were compared between the groups. Results Sixty patients who had interval CRS were included, thirty of whom received cisplatin-based HIPEC. Seven received cisplatin 50 mg/m2 without the addition of ST. Twenty three patients received cisplatin 100 mg/m2 and ST. There were no statistically differences in age, body mass index BMI, American society of anaesthesia score, estimated blood loss or peritoneal cancer index between the cohorts (p > 0.05). The only episode of acute kidney injury (AKI) was within the HIPEC cohort, after cisplatin 50 mg/m2 (without ST) and this was sustained at three months. In contrast, no patients within the CRS cohort or cisplatin 100 mg/m2 that received the addition of ST, sustained a renal injury and all had a creatinine within the normal range at three days post operatively. Conclusion The renal toxicity associated with cisplatin HIPEC and major abdominal surgery can be minimised with careful preoperative optimisation, intra operative fluid management and attention to renal function. The addition of sodium thiosulphate is a safe and effective method to minimise toxicity and should be added to any cisplatin HIPEC protocol.
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Yang SJ, Huang CH, Wang CH, Shieh MJ, Chen KC. The Synergistic Effect of Hyperthermia and Chemotherapy in Magnetite Nanomedicine-Based Lung Cancer Treatment. Int J Nanomedicine 2020; 15:10331-10347. [PMID: 33376324 PMCID: PMC7755349 DOI: 10.2147/ijn.s281029] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/05/2020] [Indexed: 12/15/2022] Open
Abstract
Background Lung cancer is the leading cause of cancer patient death in the world. There are many treatment options for lung cancer, including surgery, radiation therapy, chemotherapy, targeted therapy, and combined therapy. Despite significant progress has been made in the diagnosis and treatment of lung cancer during the past few decades, the prognosis is still unsatisfactory. Purpose To resolve the problem of chemotherapy failure, we developed a magnetite-based nanomedicine for chemotherapy acting synergistically with loco-regional hyperthermia. Methods The targeting carrier consisted of a complex of superparamagnetic iron oxide (SPIO) and poly(sodium styrene sulfonate) (PSS) at the core and a layer-by-layer shell with cisplatin (CDDP), together with methotrexate – human serum albumin conjugate (MTX−HSA conjugate) for lung cancer-specific targeting, referred to hereafter as SPIO@PSS/CDDP/HSA−MTX nanoparticles (NPs). Results SPIO@PSS/CDDP/HSA−MTX NPs had good biocompatibility and stability in physiological solutions. Furthermore, SPIO@PSS/CDDP/HSA−MTX NPs exhibited a higher temperature increase rate than SPIO nanoparticles under irradiation by a radiofrequency (RF) generator. Therefore, SPIO@PSS/CDDP/HSA−MTX NPs could be used as a hyperthermia inducer under RF exposure after nanoparticles preferentially targeted and then accumulated at tumor sites. In addition, SPIO@PSS/CDDP/HSA−MTX NPs were developed to be used during combined chemotherapy and hyperthermia therapy, exhibiting a synergistic anticancer effect better than the effect of monotherapy. Conclusion Both in vitro and in vivo results suggest that the designed SPIO@PSS/CDDP/HSA−MTX NPs are a powerful candidate nanoplatform for future antitumor treatment strategies.
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Affiliation(s)
- Shu-Jyuan Yang
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan
| | - Chung-Huan Huang
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan
| | | | - Ming-Jium Shieh
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan.,Department of Oncology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Ke-Cheng Chen
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan.,Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
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Yang SJ, Tseng SY, Wang CH, Young TH, Chen KC, Shieh MJ. Magnetic nanomedicine for CD133-expressing cancer therapy using locoregional hyperthermia combined with chemotherapy. Nanomedicine (Lond) 2020; 15:2543-2561. [DOI: 10.2217/nnm-2020-0222] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Aim: Cells with CD133 overexpression, a theoretical cancer stem cells (CSCs) marker, have been shown to induce colorectal cancer (CRC) initiation and relapse. Therefore, the detection and treatment of CSCs are the most important factors in overcoming CRC. Materials & methods: Herein, we developed a magnetite-based nanomedicine (superparamagnetic iron oxide@poly(sodium styrene sulfonate)/irinotecan/human serum albumin-anti-CD133 nanoparticle) using loco-regional hyperthermia combined with chemotherapy for CRC- and CSC-specific targeting treatment. Results: The designed nanoparticles were highly biocompatible and exhibited a higher temperature increase rate under radiofrequency generator irradiation. The nanoparticles could be used as a T2-weighted magnetic resonance imaging contrast media, and also applied during hyperthermia and chemotherapy to display a synergistic anticancer effect. Conclusion: Therefore, the superparamagnetic iron oxide@poly(sodium styrene sulfonate)/irinotecan/human serum albumin-anti-CD133 nanoparticles are a powerful candidate for future antitumor strategies.
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Affiliation(s)
- Shu-Jyuan Yang
- Institute of Biomedical Engineering, College of Medicine & College of Engineering, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei 100, Taiwan
| | - Shu-Yi Tseng
- Institute of Biomedical Engineering, College of Medicine & College of Engineering, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei 100, Taiwan
| | - Chung-Hao Wang
- Gene'e Tech Co. Ltd. 2F., No.661, Bannan Rd., Zhonghe Dist., New Taipei City 235, Taiwan
| | - Tai-Horng Young
- Institute of Biomedical Engineering, College of Medicine & College of Engineering, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei 100, Taiwan
| | - Ke-Cheng Chen
- Institute of Biomedical Engineering, College of Medicine & College of Engineering, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei 100, Taiwan
- Department of Surgery, National Taiwan University Hospital & College of Medicine, No. 7, Chung-Shan South Road, Taipei 100, Taiwan
| | - Ming-Jium Shieh
- Institute of Biomedical Engineering, College of Medicine & College of Engineering, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei 100, Taiwan
- Department of Oncology, National Taiwan University Hospital & College of Medicine, No. 7, Chung-Shan South Road, Taipei 100, Taiwan
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Chow FCL, Yip J, Foo DCC, Wei R, Choi HK, Ng KK, Lo OSH. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal and appendiceal peritoneal metastases - The Hong Kong experience and literature review. Asian J Surg 2020; 44:221-228. [PMID: 32605790 DOI: 10.1016/j.asjsur.2020.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/05/2020] [Accepted: 05/17/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is increasingly used to treat peritoneal metastases from appendiceal or colorectal origin. We evaluate our institution's experience and survival outcomes with this procedure, and its efficacy in symptom relief. METHODS This is a single-centre retrospective observational study on patients with peritoneal metastases (PM) from appendiceal neoplasm or colorectal cancer who underwent CRS/HIPEC in Queen Mary Hospital. Our primary endpoints were overall survival (OS) and morbidity and mortality of this procedure; secondary endpoints included disease-free survival (DFS) and symptom-free survival. RESULTS Between 2006 and 2018, thirty CRS/HIPEC procedures were performed for 28 patients - 17 (60.7%) had appendiceal PM while 11 (39.9%) had colorectal PM. The median peritoneal cancer index was 20; complete cytoreduction was achieved in 83.3% patients. High-grade morbidity occurred in 13.3% cases. There was no 30-day mortality. Two-year OS were 71.6% and 50% for low-grade appendiceal PM and colorectal PM patients (p = 0.20). Complete cytoreduction improved OS (2-year OS 75.4% vs 20%, p = 0.04). Median DFS was 11.8 months. Median symptom-free duration was 36.8 months; patients with complete cytoreduction were more likely to remain asymptomatic (82.9% at 1 year, vs 60% in incomplete cytoreduction group, p < 0.01). 91.7% low-grade appendiceal PM patients and 58.4% colorectal PM patients remained asymptomatic at post-operative one year (p = 0.31). CONCLUSION CRS/HIPEC is beneficial to appendiceal PM and selected colorectal PM patients - improving survival and offering prolonged symptom relief, with reasonable morbidity and mortality. Complete cytoreduction is key to realising this benefit.
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Affiliation(s)
- Felix Che-Lok Chow
- Division of Colorectal Surgery, Department of Surgery, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
| | - Jeremy Yip
- Division of Colorectal Surgery, Department of Surgery, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Dominic Chi-Chung Foo
- Division of Colorectal Surgery, Department of Surgery, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Rockson Wei
- Division of Colorectal Surgery, Department of Surgery, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Hok Kwok Choi
- Division of Colorectal Surgery, Department of Surgery, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ka Kin Ng
- Division of Colorectal Surgery, Department of Surgery, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Oswens Siu-Hung Lo
- Division of Colorectal Surgery, Department of Surgery, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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High-grade complication is associated with poor overall survival after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Int J Clin Oncol 2020; 25:984-994. [PMID: 31915944 DOI: 10.1007/s10147-019-01609-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 12/21/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is increasingly used in peritoneal carcinomatosis (PC) management. This modality is criticized for its high morbidity and mortality. We evaluate the morbidity and mortality of patients undergoing this procedure in our institution. METHODS A review of our institution's database was performed. All patients who underwent CRS/HIPEC between July 2011 and March 2018 were divided into three groups: no, low-grade, and high-grade complications. Prognostic factors were determined with Cox regression, while morbidity risk factors were analyzed using multinomial logistic regression. RESULTS 225 consecutive patients underwent CRS/HIPEC. The most common primary cancer types were colorectal (35.1%), appendiceal (25.8%), and ovarian (22.2%). Median age was 55 years old (range 14-77), and patients were typically female (68.0%). 38.7% developed low-grade complications and 14.7% had high-grade complications. No 30-day mortality was observed. Different tumor origins are associated with significant differences in overall survival (p < 0.001). Patients without complications had significantly better survival than those with high-grade complications (HR 0.35, 95% CI 0.15-0.81, p < 0.001). Males were more likely to develop low-grade complications (OR 3.30, 95% CI 1.31-8.30, p = 0.011). Intra-operative blood loss was associated with greater odds of developing any post-operative complications (OR 1.001, 95% CI 1.0003-1.002, p = 0.007; and OR 1.002, 95% CI 1.001-1.002, p < 0.001, for low and high grade, respectively). CONCLUSION Presence of high-grade complication was associated with poorer survival in patients after CRS/HIPEC. Pre-operative careful assessment of patients is pivotal to ensure favorable patient outcome following this complex procedure.
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Systematic review of published literature on oxaliplatin and mitomycin C as chemotherapeutic agents for hyperthermic intraperitoneal chemotherapy in patients with peritoneal metastases from colorectal cancer. Crit Rev Oncol Hematol 2019; 142:119-129. [PMID: 31400583 DOI: 10.1016/j.critrevonc.2019.06.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 06/28/2019] [Indexed: 12/31/2022] Open
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闵 诗, 郑 强, 张 白, 严 丹, 王 汝, 瞿 子, 李 潞, 刘 洁, 周 清. [A Meta-Analysis of Efficacy and Adverse Effects of Lobaplatin and Cisplatin in the Treatment of Malignant Pleural Effusion]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:90-98. [PMID: 30827325 PMCID: PMC6397937 DOI: 10.3779/j.issn.1009-3419.2019.02.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 01/29/2019] [Accepted: 02/11/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND The aim of this study is to systematically evaluate the efficacy and adverse effects of Lobaplatin and Cisplatin in the treatment of malignant pleural effusion. METHODS The databases of Medline (PubMed), Embase, Web of Science, Cochrane, Wanfang, CNKI and VIP were retrieved so as to search the studies about the randomized controlled clinical trials (RCT) that compared the Lobaplatin and Cisplatin for malignant pleural effusion. The main outcome indicators include objective response rate, complete response, partial response, nephrotoxicity, chest pain, gastrointestinal reaction, myelosuppression, fever response and hepatotoxicity. Relative risk was used as the effect size, which was expressed as 95% confidence interval. The meta-analysis was performed using Stata 14.0 statistical software. RESULTS A total of 12 RCTs and 720 MPE patients were included. The results showed that the ORR (RR=1.27, 95%CI: 1.15-1.40, P<0.001), CR (RR=1.39, 95%CI: 1.09-1.78, P=0.007), PR (RR=1.21, 95%CI: 1.02-1.42, P=0.026) in LBP thoracic perfusion chemotherapy were significantly higher than those in DDP thoracic perfusion chemotherapy. The incidence of nephrotoxicity (RR=0.31, 95%CI: 0.13-0.71, P=0.005) and gastrointestinal reactions (RR=0.44, 95%CI: 0.31-0.62, P<0.001) in the LBP group were significantly lower than those in DDP group. CONCLUSIONS Compared with DDP pleural perfusion chemotherapy, the ORR, CR and PR of LBP pleural perfusion chemotherapy for MPE are significantly better than DDP, and its nephrotoxicity and gastrointestinal reactions are remarkably lower than DDP.
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Affiliation(s)
- 诗惠 闵
- 610041 成都,四川大学华西医院肺癌中心Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 强强 郑
- 610041 成都,四川大学华西医院肺癌中心Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 白露 张
- 610041 成都,四川大学华西医院肺癌中心Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 丹丽 严
- 610041 成都,四川大学华西医院肺癌中心Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 汝兰 王
- 610041 成都,四川大学华西医院肺癌中心Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 子涵 瞿
- 610041 成都,四川大学华西医院肺癌中心Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 潞 李
- 610041 成都,四川大学华西医院肺癌中心Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 洁薇 刘
- 610041 成都,四川大学华西医院肺癌中心Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 清华 周
- 610041 成都,四川大学华西医院肺癌中心Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
- 300052 天津,天津医科大学总医院天津市肺癌研究所Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
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11
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Tan JWS, Teo MCC. Peritoneal Surface Oncology in Singapore. Indian J Surg Oncol 2019; 10:24-28. [PMID: 30886489 PMCID: PMC6397121 DOI: 10.1007/s13193-019-00891-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 01/25/2019] [Indexed: 11/12/2022] Open
Abstract
Peritoneal surface malignancy is now an established indication for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. The landscape of treatment in Singapore has evolved through the years, with expanded indications as the experience in the management of this disease improves.
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Affiliation(s)
- Joey Wee-Shan Tan
- Division of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
| | - Melissa Ching Ching Teo
- Division of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
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12
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Systematic Review of Variations in Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Peritoneal Metastasis from Colorectal Cancer. J Clin Med 2018; 7:jcm7120567. [PMID: 30572653 PMCID: PMC6306814 DOI: 10.3390/jcm7120567] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/05/2018] [Accepted: 12/10/2018] [Indexed: 02/07/2023] Open
Abstract
Background: Cytoreductive surgery (CRS), followed by hyperthermic intraperitoneal chemotherapy (HIPEC), combines radical surgery with abdominal heated chemotherapy, constituting a multimodal treatment approach. Since clear standards for HIPEC conduct in colorectal carcinoma (CRC) are lacking, we aimed to provide a comprehensive structured survey. Data sources and study eligibility criteria: A systematic literature search was performed in PubMed, with keywords “HIPEC” and “colorectal cancer”, according to established guidelines. Articles were systematically screened, selecting 87 publications complemented by 48 publications identified through extended search for subsequent synthesis and evaluation, extracting inter alia details on used drugs, dosage, temperature, exposure times, and carrier solutions. Results: Compiled publications contained 171 reports on HIPEC conduct foremost with mitomycin C and oxaliplatin, but also other drugs and drug combinations, comprising at least 60 different procedures. We hence provide an overview of interconnections between HIPEC protocols, used drugs and carrier solutions as well as their volumes. In addition, HIPEC temperatures and dosing benchmarks, as well as an estimate of in vivo resulting drug concentrations are demonstrated. Conclusions and implications: Owing to recent developments, HIPEC conduct and practices need to be reassessed. Unfortunately, imprecise and lacking reporting is frequent, which is why minimal information requirements should be established for HIPEC and the introduction of final drug concentrations for comparability reasons seems sensible.
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13
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Tan GHC, Chia CS, Tan SH, Soo KC, Teo MCC. Early recurrence after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Int J Clin Oncol 2018; 23:989-998. [DOI: 10.1007/s10147-018-1301-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/28/2018] [Indexed: 01/27/2023]
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14
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Wang W, Tan GHC, Chia CS, Skanthakumar T, Soo KC, Teo MCC. Are positron emission tomography-computed tomography (PET-CT) scans useful in preoperative assessment of patients with peritoneal disease before cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)? Int J Hyperthermia 2017; 34:524-531. [DOI: 10.1080/02656736.2017.1366554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Weining Wang
- National Cancer Centre Singapore, Singapore, Singapore
| | | | | | | | - Khee Chee Soo
- National Cancer Centre Singapore, Singapore, Singapore
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15
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Alyami M, Kim BJ, Villeneuve L, Vaudoyer D, Képénékian V, Bakrin N, Gilly FN, Cotte E, Glehen O, Passot G. Ninety-day post-operative morbidity and mortality using the National Cancer Institute’s common terminology criteria for adverse events better describe post-operative outcome after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Int J Hyperthermia 2017; 34:532-537. [DOI: 10.1080/02656736.2017.1367846] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Mohammad Alyami
- The Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, France
- EMR 37-38, Lyon 1 University, Lyon, France
- King Salman Scholarship Program, Saudi Arabian Cultural Bureau, Paris, France
| | - Bradford J. Kim
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Laurent Villeneuve
- The Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, France
- EMR 37-38, Lyon 1 University, Lyon, France
- Pole IMER, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, France
| | - Delphine Vaudoyer
- The Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, France
| | - Vahan Képénékian
- The Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, France
- EMR 37-38, Lyon 1 University, Lyon, France
| | - Naoual Bakrin
- The Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, France
- EMR 37-38, Lyon 1 University, Lyon, France
| | - Francois-Noel Gilly
- The Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, France
- EMR 37-38, Lyon 1 University, Lyon, France
| | - Eddy Cotte
- The Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, France
- EMR 37-38, Lyon 1 University, Lyon, France
| | - Olivier Glehen
- The Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, France
- EMR 37-38, Lyon 1 University, Lyon, France
| | - Guillaume Passot
- The Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, France
- EMR 37-38, Lyon 1 University, Lyon, France
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16
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Brandl A, Weiss S, von Winterfeld M, Krannich A, Feist M, Pratschke J, Raue W, Rau B. Predictive value of peritoneal cancer index for survival in patients with mucinous peritoneal malignancies treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a single centre experience. Int J Hyperthermia 2017; 34:512-517. [PMID: 28679331 DOI: 10.1080/02656736.2017.1351627] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES This study investigated the correlation between the peritoneal carcinomatosis index (PCI) and patient outcome depending on the tumour type. BACKGROUND Peritoneal surface malignancy (PSM) treatment depends on tumour type. Mucinous PSM (m-PSM) is associated with a better prognosis than non-mucinous PSM (nm-PSM). The PCI's predictive ability has not yet been evaluated. METHODS We analysed 123 patients with PSM treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) between 2008 and 2015. The m-PSM group (n = 75) included patients with appendiceal cancer (n = 15), colorectal cancer (n = 21), or low-grade appendiceal mucinous neoplasm (n = 39); the nm-PSM group (n = 48) included patients with gastric (n = 18) or colorectal (n = 30) cancer. The PCI's predictive ability was evaluated by multiple Cox-proportional hazard regression analysis and Kaplan-Meier curves. RESULTS The 5-year survival and PCI were higher in m-PSM patients (67.0%; 20.5 ± 12.1) than in nm-PSM patients (32.6%; p = 0.013; 8.9 ± 6.0; p < 0.001). Colorectal nm-PSM patients with PCI ≥16 had a worse 2-year survival (25.0%) vs. patients with PCI <16 (79.1%; log rank = 0.009), but no significant effect was observed in patients with m-PSM (66.7% vs. 68.1%; p = 0.935). Underlying disease (HR 5.666-16.240), BMI (HR 1.109), and PCI (HR 1.068) significantly influenced overall survival in all patients. CONCLUSIONS PCI is prognostic in nm-PSM, but not in m-PSM. CRS and HIPEC may benefit not only patients with low PCI, but also those with high PCI and m-PSM.
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Affiliation(s)
- Andreas Brandl
- a Department of General, Visceral, and Transplantation Surgery and Department of General, Visceral, Vascular, and Thoracic Surgery, Campus Virchow and Mitte, Charité , Universitätsmedizin Berlin , Berlin , Germany
| | - Sascha Weiss
- a Department of General, Visceral, and Transplantation Surgery and Department of General, Visceral, Vascular, and Thoracic Surgery, Campus Virchow and Mitte, Charité , Universitätsmedizin Berlin , Berlin , Germany
| | - Moritz von Winterfeld
- b Institute of Pathology, Campus Mitte, Charité , Universitätsmedizin Berlin , Berlin , Germany
| | - Alexander Krannich
- c Biostatistics Unit , Berlin Institute of Health and Charité Universitätsmedizin Berlin , Berlin , Germany
| | - Mathilde Feist
- a Department of General, Visceral, and Transplantation Surgery and Department of General, Visceral, Vascular, and Thoracic Surgery, Campus Virchow and Mitte, Charité , Universitätsmedizin Berlin , Berlin , Germany
| | - Johann Pratschke
- a Department of General, Visceral, and Transplantation Surgery and Department of General, Visceral, Vascular, and Thoracic Surgery, Campus Virchow and Mitte, Charité , Universitätsmedizin Berlin , Berlin , Germany
| | - Wieland Raue
- a Department of General, Visceral, and Transplantation Surgery and Department of General, Visceral, Vascular, and Thoracic Surgery, Campus Virchow and Mitte, Charité , Universitätsmedizin Berlin , Berlin , Germany
| | - Beate Rau
- a Department of General, Visceral, and Transplantation Surgery and Department of General, Visceral, Vascular, and Thoracic Surgery, Campus Virchow and Mitte, Charité , Universitätsmedizin Berlin , Berlin , Germany
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17
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Feng X, Zhu L, Xiong X, Jiang H, Wu Z, Meng W, Xu Y, Zhang S, Ma S. Therapeutical effect of intrapleural perfusion with hyperthermic chemotherapy on malignant pleural effusion under video-assisted thoracoscopic surgery. Int J Hyperthermia 2017; 34:479-485. [PMID: 28678571 DOI: 10.1080/02656736.2017.1340676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Patients with malignant pleural effusions (MPEs) have limited life expectancy. This study aims to investigate the feasibility of intrapleural perfusion with hyperthermic chemotherapy (IPHC) under video-assisted thoracoscopic surgery on MPE patients. METHODS MPE patients were enrolled in the study and treated with IPHC. The treatment response was classified as complete response (CR, no re-accumulation of pleural fluid for 4 weeks), partial response (PR, re-accumulation above the post-IPHC level but below the pre-IPHC level for four weeks), no response (NR; re-accumulation or above the pre-IPHC level). The change of Karnofsky performance score (KPS) and tumour markers were also recorded. Follow-up was done every two weeks during first month and monthly thereafter until death. RESULTS Eighty patients included 46 males and 34 females were included in the study. The total response rate was 100%, with 71.3% of CR and 28.7% of PR. The KPS scores were significantly elevated and the level of tumour markers in pleural effusion were dramatically decreased after IPHC. The median survival was 16.8 months ranged from 2.1 to 67.4 months. One-year and two-year survival rates were 82.5% and 23.8%, respectively. There were no serious clinical compilations during IPHC treatment. CONCLUSIONS IPHC is a safety, effective and promising approach for MPE patients. It provides well survival benefit and minor toxicities.
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Affiliation(s)
- Xing Feng
- a Hangzhou First People's Hospital, Nanjing Medical University , Hangzhou , PR China
| | - Lucheng Zhu
- a Hangzhou First People's Hospital, Nanjing Medical University , Hangzhou , PR China.,b Hangzhou Cancer Hospital , Hangzhou , PR China
| | - Xiaoling Xiong
- c Sir Run Run Shaw Hospital Affiliated with School of Medicine , Zhejiang University , Hangzhou , PR China
| | - Hong Jiang
- a Hangzhou First People's Hospital, Nanjing Medical University , Hangzhou , PR China
| | - Zhibing Wu
- b Hangzhou Cancer Hospital , Hangzhou , PR China
| | - Wen Meng
- a Hangzhou First People's Hospital, Nanjing Medical University , Hangzhou , PR China
| | - Yasi Xu
- a Hangzhou First People's Hospital, Nanjing Medical University , Hangzhou , PR China
| | - Shirong Zhang
- a Hangzhou First People's Hospital, Nanjing Medical University , Hangzhou , PR China
| | - Shenglin Ma
- a Hangzhou First People's Hospital, Nanjing Medical University , Hangzhou , PR China
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18
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Wang TY, Chen CY, Lu CH, Chen MC, Lee LW, Huang TH, Hsieh MC, Chen CJ, Yu CM, Chuang HC, Liao TT, Tseng CW, Huang WS. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal malignancy: preliminary results of a multi-disciplinary teamwork model in Asia. Int J Hyperthermia 2017; 34:328-335. [PMID: 28562119 DOI: 10.1080/02656736.2017.1337238] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Ting-Yao Wang
- Department of Hematology and Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Peritoneal Malignancy Program of Cancer Centre, Chang-Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chao-Yu Chen
- Peritoneal Malignancy Program of Cancer Centre, Chang-Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Gynecology and Obstetrics, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Taiwan
| | - Chang-Hsien Lu
- Department of Hematology and Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Peritoneal Malignancy Program of Cancer Centre, Chang-Gung Memorial Hospital, Chiayi, Taiwan
| | - Min-Chi Chen
- Department of Hematology and Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Biostatistics Consulting Centre and Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Li-Wen Lee
- Peritoneal Malignancy Program of Cancer Centre, Chang-Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Taiwan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Tzu-Hao Huang
- Peritoneal Malignancy Program of Cancer Centre, Chang-Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Meng-Chiao Hsieh
- Peritoneal Malignancy Program of Cancer Centre, Chang-Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Colorectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chih-Jung Chen
- Peritoneal Malignancy Program of Cancer Centre, Chang-Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Colorectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chung-Ming Yu
- Peritoneal Malignancy Program of Cancer Centre, Chang-Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Anesthesia, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Huei-Chieh Chuang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Pathology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Tzu-Ting Liao
- Peritoneal Malignancy Program of Cancer Centre, Chang-Gung Memorial Hospital, Chiayi, Taiwan
- Department of Cancer Centre, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chih-Wen Tseng
- Department of Hematology and Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Peritoneal Malignancy Program of Cancer Centre, Chang-Gung Memorial Hospital, Chiayi, Taiwan
| | - Wen-Shih Huang
- Peritoneal Malignancy Program of Cancer Centre, Chang-Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Colorectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
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