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Patel S, Bhatt A, Mehta S, Ramakrishnan AS. Two-stage cytoreductive surgery for 'extensive' pseudomyxoma peritonei: A legitimate alternative or salvage strategy? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108593. [PMID: 39121632 DOI: 10.1016/j.ejso.2024.108593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 08/06/2024] [Accepted: 08/06/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND AND AIM Two-stage cytoreductive surgery (CRS) has been proposed as an alternative to one-stage surgery in patients who have 'extensive' pseudomyxoma peritonei (PMP) and/or are unfit for very extensive surgery, to reduce morbidity. We review current evidence on two-stage CRS focusing on patient selection, interval between procedures, extent of surgery, use of HIPEC, perioperative and oncological outcomes. METHODS This is a narrative review. A literature search on PubMed and Embase was performed using keywords- 'Two-stage cytoreductive surgery', 'pseudomyxoma peritonei', 'high-volume PMP', 'huge PMP', 'cytoreductive surgery', 'HIPEC', 'staged surgery' and 'extensive pseudomyxoma peritonei'. RESULTS Five studies reported outcomes in a total of 114 patients. The indications for two-stage CRS were: in two studies, patients undergoing an incomplete cytoreduction due to undue surgical risk were reevaluated for a second surgery during routine surveillance; severe comorbidities in one; extensive disease with PCI>28 in another and in one, only HIPEC was performed as a second procedure due to intraoperative hemodynamic instability (the two-stage procedure was performed in interest of patient's safety). Major morbidity ranged from 0 to 37.5 % (first-stage) and 25%-38.9 % (second-stage). Short term follow-up demonstrated equivalent short-term oncological outcomes compared to historical data. Long term follow-up and quality-of-life data were not available. CONCLUSIONS The published studies showed different interpretations and applications of the two-stage CRS concept. The reported morbidity was similar to that after single-stage CRS for extensive PMP. Though short-term survival outcomes are acceptable, long-term follow-up is needed. Planned two-stage CRS should currently be reserved for highly selected clinical situations.
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Affiliation(s)
- Swapnil Patel
- Dept of Surgical Oncology, MPMMCC & HBCH, Tata Memorial Centre, Varanasi, India
| | - Aditi Bhatt
- Dept of Surgical Oncology, KD Hospital, Ahmedabad, India.
| | - Sanket Mehta
- Dept of Surgical Oncology, Specialty Surgical Oncology, Mumbai, India
| | - A S Ramakrishnan
- Dept. of Surgical Oncology, Cancer Institute, WIA, Chennai, India
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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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Ionescu S, Marincas M, Madge OL, Dicu-Andreescu IG, Chitoran E, Rotaru V, Cirimbei C, Gherghe M, Ene A, Rosca R, Radu M, Simion L. Ovarian Causes of Pseudomyxoma Peritonei (PMP)-A Literature Review. Cancers (Basel) 2024; 16:1446. [PMID: 38672528 PMCID: PMC11047873 DOI: 10.3390/cancers16081446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/04/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Pseudomyxoma peritonei (PMP) is a rare, progressive, slowly growing, inadequately understood neoplasm with a 5-year progression-free survival rate of as low as 48%. It is characterized by varying degrees of malignancy and the production of mucinous and gelatinous structures. Typically, the development of pseudomyxoma peritonei is associated with the rupture of appendiceal mucinous tumors and other gastrointestinal or ovarian mucinous tumors. The goal of our literature review was to identify various aspects that characterize the ovarian causes of pseudomyxoma peritonei. MATERIALS AND METHODS The authors performed an extensive literature search between 1 February 2024 and 2 March 2024 on the following databases: Pubmed, Scopus, Oxford Journals, and Reaxys, and the findings were summarized into seven main clinical and paraclinical situations. RESULTS According to our research, the main instances in which pseudomyxoma peritonei can be triggered by an ovarian cause are the following: (1) mucinous cystadenoma; (2) mucinous ovarian cancer; (3) colon cancer with ovarian metastasis; (4) malignant transformation of an ovarian primary mature cystic teratoma; (5) appendiceal mucocele with peritoneal dissemination mimicking an ovarian tumor with peritoneal carcinomatosis; (6) mucinous borderline tumor developing inside an ovarian teratoma; and (7) the association between a mucinous bilateral ovarian cancer and a colonic tumor. CONCLUSIONS In our study, we aimed to provide a comprehensive overview of the ovarian causes of pseudomyxoma peritonei, including its epidemiology, imagery characteristics, symptoms, current treatment, and promising future therapies, in the hopes of finding feasible solutions, as a lack of understanding of this mucus-secreting malignant disease increases the risk of delayed diagnosis or uncontrolled deterioration.
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Affiliation(s)
- Sinziana Ionescu
- Surgery Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.); (E.C.); (V.R.); (C.C.); (L.S.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania; (O.L.M.); (I.G.D.-A.)
| | - Marian Marincas
- Surgery Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.); (E.C.); (V.R.); (C.C.); (L.S.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania; (O.L.M.); (I.G.D.-A.)
| | - Octavia Luciana Madge
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania; (O.L.M.); (I.G.D.-A.)
- Faculty of Letters, University of Bucharest, 030018 Bucharest, Romania
| | - Irinel Gabriel Dicu-Andreescu
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania; (O.L.M.); (I.G.D.-A.)
| | - Elena Chitoran
- Surgery Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.); (E.C.); (V.R.); (C.C.); (L.S.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania; (O.L.M.); (I.G.D.-A.)
| | - Vlad Rotaru
- Surgery Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.); (E.C.); (V.R.); (C.C.); (L.S.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania; (O.L.M.); (I.G.D.-A.)
| | - Ciprian Cirimbei
- Surgery Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.); (E.C.); (V.R.); (C.C.); (L.S.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania; (O.L.M.); (I.G.D.-A.)
| | - Mirela Gherghe
- Surgery Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.); (E.C.); (V.R.); (C.C.); (L.S.)
- The Clinical Nuclear Medicine Laboratory, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Adina Ene
- Pathology Department, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania; (A.E.); (M.R.)
| | - Robert Rosca
- Pathology Department, Bucharest Emergency University Hospital, 050098 Bucharest, Romania;
| | - Madalina Radu
- Pathology Department, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania; (A.E.); (M.R.)
| | - Laurentiu Simion
- Surgery Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.); (E.C.); (V.R.); (C.C.); (L.S.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania; (O.L.M.); (I.G.D.-A.)
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Pawar A, Warikoo V, Salunke A, Sharma M, Pandya S, Bhardwaj A, KS S, Aaron J. Outcomes of minimal access cytoreductive surgery (M-CRS) and HIPEC/EPIC vs. open cytoreductive surgery (O-CRS) and HIPEC/EPIC in patients with peritoneal surface malignancies: a meta-analysis. Pleura Peritoneum 2024; 9:1-13. [PMID: 38558870 PMCID: PMC10980983 DOI: 10.1515/pp-2023-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/15/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Minimal Access Surgery (MAS) has shown better peri-operative outcomes with equivalent oncological outcomes in gastrointestinal and thoracic oncology. Open CRS (O-CRS) procedure accompanies inevitable and significant surgical morbidity in patients. The aim of the review article is to compare outcomes of M-CRS and HIPEC/EPIC with open procedure in peritoneal surface malignancies. Content Comprehensive search of databases was done and total 2,807 articles were found (2793-PubMed and 14-Cochrane review). PRISMA flow chart was prepared and 14 articles were selected. Meta-analysis was performed according to PRISMA guidelines using random-effects model (DerSimonian Laird) and fixed effect model. Publication bias was tested with Funnel plot and Egger's regression test. Quality of studies was assessed by Newcastle-Ottawa scale. Summary and Outlook Patients in both groups [total (732), M-CRS(319), O-CRS(413)] were similar in demographic characteristics. Peri-operative outcomes were significantly better in M-CRS group in terms of blood loss SMD=-2.379, p<0.001 (95 % CI -2.952 to -1.805), blood transfusion RR=0.598, p=0.011 (95 % CI 0.402 to 0.889), bowel recovery SMD=-0.843, p=0.01 (95 % CI -1.487 to -0.2), hospital stay SMD=-2.348, p<0.001 (95 % CI -3.178 to -1.519) and total morbidity RR=0.538, p<0.001 (95 % CI 0.395 to 0.731). Duration of surgery SMD=-0.0643 (95 % CI -0.993 to 0.865, p=0.892) and CC0 score RR=1.064 (95 % CI 0.992 to 1.140, p=0.083) had no significant difference. Limited studies which evaluated survival showed similar outcomes. This meta-analysis shows that M-CRS and HIPEC/EPIC is feasible and has better peri-operative outcomes compared to open procedure in patients with limited peritoneal carcinoma index (PCI) peritoneal surface malignancies. Survival outcomes were not calculated. Further studies are warranted in this regard.
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Affiliation(s)
- Ajinkya Pawar
- Department of Surgical Oncology, GCRI, Ahmedabad, India
| | - Vikas Warikoo
- Department of Surgical Oncology, GCRI, Ahmedabad, India
| | | | - Mohit Sharma
- Department of Surgical Oncology, GCRI, Ahmedabad, India
| | | | - Amol Bhardwaj
- Department of Surgical Oncology, GCRI, Ahmedabad, India
| | - Sandeep KS
- Department of Surgical Oncology, GCRI, Ahmedabad, India
| | - Jebin Aaron
- Department of Surgical Oncology, GCRI, Ahmedabad, India
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Kopetskyi V, Antoniv M, Yarema R, Maksymovskyi V, Chetverikova-Ovchinnik V, Kryzhevskyi V, Volodko N, Gushchin V, Nikiforchin A. Building an Efficient Peritoneal Surface Malignancies Program Despite the Lower-Middle-Income Barriers: Ukraine Experience. JCO Glob Oncol 2024; 10:e2300432. [PMID: 38330272 DOI: 10.1200/go.23.00432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 11/26/2023] [Accepted: 12/04/2023] [Indexed: 02/10/2024] Open
Abstract
PURPOSE Cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) programs are often limited to centers in developed countries because of extensive requirements. We aimed to analyze efficacy and challenges of CRS/HIPEC centers in lower-middle-income settings in the Ukraine example. METHODS A multicenter descriptive study was conducted using data sets (2008-2022) from Kyiv, Lviv, and Odesa centers. Patients with appendiceal neoplasm (AN); colorectal cancer (CRC); malignant peritoneal mesothelioma (MPM); and epithelial ovarian, fallopian tube, and primary peritoneal cancer (EOC) treated with CRS ± HIPEC were included. Overall survival (OS) was analyzed for N ≥ 20 cohorts using the Kaplan-Meier method. RESULTS We included 596 patients. At Kyiv and Lviv centers, 37 and 28 patients with AN had completeness of cytoreduction (CC-0/1) rates of 84% and 71%, respectively. Thirty-day major morbidity stood at 24% and 18%, respectively. Median OS was not reached (NR) at both centers. Nineteen patients with CRC from Kyiv, 11 from Lviv, and 156 from Odesa had CC-0/1 rates of 84%, 91%, and 86%, respectively. Thirty-day major complications occurred in 16%, 18%, and 8%, respectively. Median OS in the Odesa cohort was 35 (95% CI, 32 to 38) months. Among 15 Kyiv, five Lviv, and six Odesa patients with MPM, CC-0/1 rates were 67%, 80%, and 100%, respectively, while major complications occurred in 13%, 0%, and 17%, respectively. OS was not analyzed because of small MPM cohorts. At Kyiv, Lviv, and Odesa centers, 91, 40, and 89 patients, respectively, had primary EOC. CC-0/1 rates were 79%, 100%, and 80%, and 30-day major morbidity rates were 23%, 5%, and 6%, respectively. Median OS was NR, 71 (95% CI, 32 to 110), and 67 (95% CI, 61 to 73) months, respectively. CONCLUSION CRS/HIPEC programs in lower-middle-income environment can achieve safety and survival that meet global standards. Our discussion highlights common obstacles in such settings and proposes effective overcoming strategies.
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Affiliation(s)
- Viacheslav Kopetskyi
- Department of Hepatopancreatobiliary Surgery, National Cancer Institute, Kyiv, Ukraine
| | - Marta Antoniv
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
| | - Roman Yarema
- Department of Oncology, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | | | | | - Vitalii Kryzhevskyi
- Department of Hepatopancreatobiliary Surgery, National Cancer Institute, Kyiv, Ukraine
| | - Nataliya Volodko
- Department of Oncology, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Vadim Gushchin
- Department of Surgical Oncology, Mercy Medical Center, Baltimore, MD
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Sedighim S, Khan A, Li AY, Tajik F, Radhakrishnan VK, Eng O, Turaga K, Senthil M. Adoption of cytoreductive surgery in the management of peritoneal malignancies-Global trends. J Surg Oncol 2023; 128:1021-1031. [PMID: 37818906 DOI: 10.1002/jso.27448] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 10/13/2023]
Abstract
Cytoreductive surgery (CRS) has now been accepted as an integral component in the management of gastrointestinal and gynecological cancers with peritoneal metastases. Since the adoption of CRS is influenced by access to advanced medical facilities, trained multidisciplinary teams, and funding, there is wide variability in incorporation of CRS into routine clinical practice between high- versus low- and middle-income countries. This review highlights the global trends in the adoption of CRS for peritoneal malignancies with a specific focus on the establishment of CRS programs and barriers to incorporate CRS into routine clinical care in low- and middle-income countries.
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Affiliation(s)
- Shaina Sedighim
- Department of Surgery, University of California, Irvine, California, USA
| | - Aaqil Khan
- Department of Surgery, University of California, Irvine, California, USA
- School of Medicine, University of California, Irvine, California, USA
| | - Amy Y Li
- Division of Surgical Oncology, Department of Surgery, University of California Irvine Medical Center, Orange, California, USA
| | - Fatemeh Tajik
- Department of Surgery, University of California, Irvine, California, USA
| | | | - Oliver Eng
- Division of Surgical Oncology, Department of Surgery, University of California Irvine Medical Center, Orange, California, USA
| | - Kiran Turaga
- Division of Surgical Oncology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Maheswari Senthil
- Department of Surgery, University of California, Irvine, California, USA
- Division of Surgical Oncology, Department of Surgery, University of California Irvine Medical Center, Orange, California, USA
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Deo SVS, Bansal B, Kumar S. How to Develop and Implement Computerized Comprehensive Clinical Database in Oncology-the Way Forward. Indian J Surg Oncol 2023; 14:1-5. [PMID: 36891426 PMCID: PMC9986356 DOI: 10.1007/s13193-023-01722-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/13/2023] [Indexed: 02/27/2023] Open
Affiliation(s)
- S. V. S. Deo
- Department of Surgical Oncology, BRA-IRCH and National Cancer Institute, AIIMS, New Delhi, 110029 India
| | - Babul Bansal
- Department of Surgical Oncology, BRA-IRCH and National Cancer Institute, AIIMS, New Delhi, 110029 India
| | - Sunil Kumar
- Department of Surgical Oncology, BRA-IRCH and National Cancer Institute, AIIMS, New Delhi, 110029 India
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Mishra N, Kumar M, Singh S, Rani K. Re-do cytoreductive surgery with hyperthermic intra-peritoneal chemotherapy (HIPEC): Risk factors and complications. J Cancer Res Ther 2023; 19:S921-S924. [PMID: 38384080 DOI: 10.4103/jcrt.jcrt_354_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 06/20/2022] [Indexed: 02/23/2024]
Abstract
ABSTRACT An effective multi-modal treatment option for patients with peritoneal surface metastatic malignancies has progressed and developed over the decades as cytoreductive surgery (CRS), and hyperthermic intra-peritoneal chemotherapy (HIPEC) delivers highly concentrated, heated chemotherapy drugs directly to the abdomen during surgery. Peritoneal metastasis and high staging abdominal malignancies were considered incurable and end up with the palliation only; the CRS+HIPEC combination approach increases the median survival rate and gives a better quality of life to these patients. It is a complicated surgery which poses a high rate of complications and challenges which are difficult to manage and requires a multi-disciplinary approach. The aim of this study is to elaborate the perioperative possible physiological changes, risk factors, and related complications after re-do HIPEC.
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Affiliation(s)
- Namita Mishra
- Department of Anesthesiology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Madhav Kumar
- Department of Cardiothoracic Surgery, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Soumya Singh
- Department of Anesthesiology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Khushbu Rani
- Department of Anesthesiology, All India Institute of Medical Sciences, Patna, Bihar, India
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Van Christ Manirakiza A, Pfaendler KS. Breast, Ovarian, Uterine, Vaginal, and Vulvar Cancer Care in Low- and Middle-Income Countries. Obstet Gynecol Clin North Am 2022; 49:783-793. [DOI: 10.1016/j.ogc.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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10
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Ma J, Zhang S. Prognostic factors of malignant peritoneal mesothelioma: a retrospective study of 52 female patients. World J Surg Oncol 2022; 20:219. [PMID: 35765009 PMCID: PMC9241280 DOI: 10.1186/s12957-022-02688-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prognosis in malignant peritoneal mesothelioma (MPM) remains poor, and the associated factors are unclear. Therefore, this study aimed to investigate the prognostic factors of MPM. METHODS A total of 52 female MPM patients treated in 2012-2017 were retrospectively analyzed. Kaplan-Meier survival curves were generated for survival analysis by the log-rank test. The Cox regression model was used for univariate and multivariate analyses. RESULTS Univariate analysis showed that median survival time (MST) was longer in the epithelioid type compared with the sarcomatoid type (12 months vs 5 months); cumulative survival rates at 12 months were 45.7% and 0%, respectively (P=0.005). MST was longer in patients with proliferating cell nuclear antigen (Ki67) ≤ 10% compared with those with Ki67 > 10% (15 months vs 11 months). Cumulative survival rates at 12 months were 60.0% and 28.1%, respectively (P=0.036). MSTs in patients administered peritoneal biopsy or adnexectomy + paclitaxel + platinum perfusion, peritoneal biopsy (or adnexectomy) + pemetrexed + platinum perfusion, cytoreductive surgery + paclitaxel + platinum perfusion, and cytoreductive surgery + pemetrexed + platinum perfusion were 6, 11, 12, and 24 months, respectively, with cumulative survival rates at 12 months of 0%, 35.7%, 45.5%, and 73.3%, respectively. Survival time after cytoreductive surgery combined with pemetrexed + platinum was the longest. In multivariate analysis, pathological type, T staging, and therapeutic regimen were independent prognostic factors of MPM (P < 0.05). CONCLUSIONS Prognosis in MPM is associated with pathological subtype, clinical staging, cytoreductive surgery, and subsequent pemetrexed use. Radical cytoreductive surgery and postoperative use of pemetrexed prolong survival.
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Affiliation(s)
- Jianting Ma
- Obstetrics and Gynecology Department, Yuyao People's Hospital of Zhejiang Province, Yuyao, 315400, Zhejiang, China.
| | - Shengzhi Zhang
- Obstetrics and Gynecology Department, Yuyao People's Hospital of Zhejiang Province, Yuyao, 315400, Zhejiang, China
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Wong JSM, Tan GHC, Cheok SHX, Ong CAJ, Chia CS, Teo MCC. Implications of peritoneal cancer index distribution on patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Pleura Peritoneum 2022; 7:95-102. [PMID: 35812008 PMCID: PMC9166179 DOI: 10.1515/pp-2021-0150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 03/23/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives Peritoneal cancer index (PCI) score is a common prognostication tool in peritoneal metastases (PM). We hypothesize that the distribution of PCI score and involvement of specific regions affects survival and morbidity outcomes. Methods Data was collected from a prospective database of patients who underwent CRS and HIPEC for PM at the National Cancer Centre Singapore. We evaluate the relationship between PCI, PCI distribution, and survival and morbidity outcomes. Results One hundred and fifty-two patients underwent CRS and HIPEC with a median PCI score of nine (range 0–31). Median overall survival (OS) and progression free survival (PFS) were 43 and 17 months, respectively. Region six (pelvis) was most commonly involved and had the highest frequency of heavy disease burden. Presence of PM in the lower abdomen, flanks, and small bowel were associated with poorer OS (p=0.01, 0.03, <0.001) and PFS (p=0.04, 0.02, <0.001). Involvement of porta hepatitis predicted poorer OS but not PFS (p=0.03). Involvement of the gastric antrum resulted in higher rates of postoperative complications. Conclusions The pattern of PCI distribution may be associated with varying survival and morbidity outcomes.
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Affiliation(s)
- Jolene Si Min Wong
- Department of Sarcoma , Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore , Singapore , Singapore
- Department of Sarcoma , Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital , Singapore , Singapore
- SingHealth Duke-NUS Surgery Academic Medical Program, Duke-NUS Medical School , Singapore , Singapore
- SingHealth Duke-NUS Oncology Academic Medical Program, Duke-NUS Medical School , Singapore , Singapore
| | - Grace Hwei Ching Tan
- Department of Sarcoma , Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore , Singapore , Singapore
- Department of Sarcoma , Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital , Singapore , Singapore
| | - Sabrina Hui Xian Cheok
- Department of Sarcoma , Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore , Singapore , Singapore
- Department of Sarcoma , Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital , Singapore , Singapore
| | - Chin-Ann Johnny Ong
- Department of Sarcoma , Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore , Singapore , Singapore
- Department of Sarcoma , Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital , Singapore , Singapore
- SingHealth Duke-NUS Surgery Academic Medical Program, Duke-NUS Medical School , Singapore , Singapore
- SingHealth Duke-NUS Oncology Academic Medical Program, Duke-NUS Medical School , Singapore , Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore , Singapore , Singapore
| | - Claramae Shulyn Chia
- Department of Sarcoma , Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore , Singapore , Singapore
- Department of Sarcoma , Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital , Singapore , Singapore
- SingHealth Duke-NUS Surgery Academic Medical Program, Duke-NUS Medical School , Singapore , Singapore
- SingHealth Duke-NUS Oncology Academic Medical Program, Duke-NUS Medical School , Singapore , Singapore
| | - Melissa Ching Ching Teo
- Department of Sarcoma , Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore , Singapore , Singapore
- Department of Sarcoma , Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital , Singapore , Singapore
- SingHealth Duke-NUS Surgery Academic Medical Program, Duke-NUS Medical School , Singapore , Singapore
- SingHealth Duke-NUS Oncology Academic Medical Program, Duke-NUS Medical School , Singapore , Singapore
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