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Berger Y, Sullivan BJ, Bekhor EY, Carpiniello M, Leigh NL, Pletcher ER, Solomon D, Sarpel U, Hiotis SP, Labow DM, Cohen NA, Golas BJ. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: Effects of postoperative fluids beyond the first 24 h. J Surg Oncol 2023; 128:1133-1140. [PMID: 37519102 DOI: 10.1002/jso.27407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 06/27/2023] [Accepted: 07/16/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND AND OBJECTIVES There are no guidelines for intravenous fluid (IVF) administration after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). This study assessed rates of post-CRS/HIPEC morbidity according to perioperative IVF administration. METHODS All patients undergoing CRS/HIPEC March 2007 to June 2018 were reviewed, recording clinicopathologic, operative, and postoperative variables. Patients were divided by peritoneal cancer index (PCI), comparing IVF volumes and types administered intraoperatively and during the first 72 h postoperatively. Optimal IVF rate cutoffs calculated using area under the receiver operating characteristic curves and Youden's index determined associations with complications. RESULTS Overall, 185 patients underwent CRS/HIPEC, and 81 (51%) had low PCI (<10) and 77 (49%) had high PCI (≥10). In low-PCI patients, high IVF rates on postoperative days (POD) #0-2 were associated with higher overall complications: POD#0 (46% vs. 89%, p = 0.001), POD#1 (40% vs. 86%, p < 0.05), and POD#2 (42% vs. 72%, p < 0.05). High IVF rates were associated with respiratory distress (7% vs. 26%, p = 0.02) on POD#0, ileus (14% vs. 47%, p = 0.007) and intensive care unit stay (11% vs. 33%, p = 0.022) on POD#1, and ICU stay (8% vs. 33%, p = 0.003) on POD#2. CONCLUSIONS For low PCI patients undergoing CRS/HIPEC, higher IVF rates were associated with postoperative complications. Post-CRS/HIPEC, IVF rates should be limited to prevent morbidity.
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Affiliation(s)
- Yael Berger
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brianne J Sullivan
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eliahu Y Bekhor
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Matthew Carpiniello
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Natasha L Leigh
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eric R Pletcher
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel Solomon
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Umut Sarpel
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Spiros P Hiotis
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel M Labow
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Noah A Cohen
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Benjamin J Golas
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Pletcher E, Cha DE, Gleeson E, Shaltiel T, Magge D, Sarpel U, Cohen N, Labow D, Golas B. Postoperative Respiratory Failure Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy is Associated with Volume of Intraoperative Crystalloid Administration and Worse Survival. Ann Surg Oncol 2023; 30:437-444. [PMID: 35907991 DOI: 10.1245/s10434-022-12199-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/25/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Postoperative respiratory failure (PRF) is associated with increased morbidity after surgery. This retrospective study explores preoperative and perioperative risk factors associated with PRF in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) and the resultant impact on survival. METHODS We identified all patients who underwent CRS/HIPEC at our institution between 2007 and 2017. PRF was defined as mechanical ventilation for more than 48 h after surgery or reintubation not related to an additional procedure within the first 30 days postoperatively. The relationship between clinicopathologic variables and PRF was examined using Kaplan-Meier log-rank survival analysis and multivariable Cox regression models with 90-day, 1-year and 5-year overall survival (OS). RESULTS Overall, 314 patients underwent CRS/HIPEC, of whom 24 patients (7.6%) developed PRF. On univariable analysis, chronic obstructive pulmonary disease (COPD) was the only preoperative risk factor associated with PRF (p = 0.049). Of the intraoperative risk factors, diaphragmatic resection (p = 0.008), Peritoneal Cancer Index (PCI) > 20 (p < 0.001), and volume of intraoperative crystalloid (p < 0.001) were all associated with PRF. On multivariable Cox regression, only intraoperative crystalloid was significantly associated with PRF (p < 0.001), with a volume above 5.3 L (area under the curve [AUC] 0.77) having a high predictive accuracy for PRF. Five-year OS was significantly decreased in patients with PRF (30.2% vs. 52.6%, hazard ratio 2.6, 95% confidence interval 1.5-4.4; p < 0.001). CONCLUSIONS Liberal intraoperative crystalloid volume resuscitation is a potential independent, modifiable intraoperative risk factor for PRF following CRS/HIPEC that may contribute to decreased long-term OS.
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Affiliation(s)
- Eric Pletcher
- Division of Surgical Oncology, Department of Surgery, Mount Sinai West, New York, NY, USA.
| | - Da Eun Cha
- Division of Surgical Oncology, Department of Surgery, Mount Sinai West, New York, NY, USA
| | - Elizabeth Gleeson
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tali Shaltiel
- Department of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
| | - Deepa Magge
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Umut Sarpel
- Department of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
| | - Noah Cohen
- Department of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
| | - Daniel Labow
- Department of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
| | - Benjamin Golas
- Department of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
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Invited Commentary: Stapled Diaphragmatic Resection in Cytoreductive Surgery with Intraperitoneal Chemotherapy: A Potential Solution to a Difficult Scenario. J Am Coll Surg 2022; 234:e7-e8. [PMID: 35703833 DOI: 10.1097/xcs.0000000000000166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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4
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Hanna DN, Schlegel C, Ghani MO, Hermina A, Mina A, McKay K, Bailey CE, Magge D, Idrees K. Stapled Full-Thickness Diaphragm Resection: A Novel Approach to Diaphragmatic Resection in Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy. J Am Coll Surg 2022; 234:e1-e6. [PMID: 35258488 PMCID: PMC9203920 DOI: 10.1097/xcs.0000000000000152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Full-thickness diaphragm resection (FT-DR) during cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is sometimes required to achieve a complete cytoreduction. It is conventionally performed with electrocautery with primary repair or mesh repair. FT-DR using a linear cutting stapler is a novel technique that avoids entry to the chest cavity and minimizes the use of electrocautery on the diaphragm. We performed an institutional retrospective review of a prospectively maintained database of 145 patients who underwent CRS-HIPEC between 2013 and 2019. Patients were divided into the Conventional or Stapled group based on the FT-DR approach indicated in the operative report. Of the 145 patients who underwent CRS-HIPEC, 27 underwent FT-DR, with 63% (n = 17) in the Stapled group. There were no significant demographic or oncologic differences between the 2 groups. Patients in the Stapled group underwent tube thoracostomy (13.3% vs 60%; p = 0.008), were diagnosed with pneumonia (12% vs 50%; p = 0.04), required reintubation (6% vs 40%; p = 0.03), and required mechanical ventilation more than 48 hours (6% vs 50%; p = 0.02) less frequently than the Conventional group. There was no difference in pleural recurrence between the 2 groups (Conventional 20% vs Stapled 12%, p = 0.56). Stapled full-thickness diaphragm resection is a novel approach to achieving a complete cytoreduction that excludes the pleural cavity, minimizes diaphragm manipulation, and is associated with improved postoperative pulmonary outcomes in patients undergoing CRS-HIPEC.
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Affiliation(s)
- David N. Hanna
- Vanderbilt University Medical Center, Section of Surgical Sciences, Division of Surgical Oncology and Endocrine Surgery, Nashville, TN
| | - Cameron Schlegel
- Allegheny Health Network Cancer Institute, Department of Surgery, Division of Surgical Oncology, Pittsburgh, PA
| | - Muhammad O. Ghani
- Vanderbilt University Medical Center, Section of Surgical Sciences, Division of Surgical Oncology and Endocrine Surgery, Nashville, TN
| | | | | | - Katlyn McKay
- Vanderbilt University School of Medicine, Nashville, TN
| | - Christina E. Bailey
- Vanderbilt University Medical Center, Section of Surgical Sciences, Division of Surgical Oncology and Endocrine Surgery, Nashville, TN
| | - Deepa Magge
- Vanderbilt University Medical Center, Section of Surgical Sciences, Division of Surgical Oncology and Endocrine Surgery, Nashville, TN
| | - Kamran Idrees
- Vanderbilt University Medical Center, Section of Surgical Sciences, Division of Surgical Oncology and Endocrine Surgery, Nashville, TN
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Nikiforchin A, Gushchin V, Sittig M, Baron E, Lopez-Ramirez F, Nieroda C, Sardi A. Outcomes Following Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy with and without Diaphragmatic Resection in Patients with Peritoneal Metastases. Ann Surg Oncol 2021; 29:873-882. [PMID: 34546479 DOI: 10.1245/s10434-021-10669-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/01/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Diaphragmatic resection (DR) is often required during cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) to achieve complete cytoreduction (CC). While CC provides the best survival, requiring a DR may indicate unfavorable tumor biology. We assessed how DR during CRS/HIPEC affects outcomes. METHODS A retrospective cohort study was conducted using a prospective single-center database from October 1994-May 2020. Peritoneal surface malignancy patients who underwent CRS/HIPEC with CC-0/1/2 were assigned to DR and NoDR groups. Survival was measured using the Kaplan-Meier method. Subgroup analysis was performed for patients with peritoneal cancer index (PCI) ≥ 20 to eliminate confounding of more extensive disease in DR. RESULTS Of 824 CRS/HIPECs, 774 were included: 134 DR and 640 NoDR. PCI was significantly higher in DR: 29 versus 21, p < 0.001. CC-0/1 rate was 89% in DR and 95% in NoDR (p = 0.003). Neither 100-day morbidity nor mortality differed between the groups (p = 0.355 and p = 1.000). Median follow-up was 64 months. Median overall survival (OS) was significantly lower in DR (32 vs. 96 months, p < 0.001). Subgroup analysis by tumor type in patients with PCI ≥ 20 showed significantly shorter OS in DR than NoDR in appendiceal (40 vs. 196 months, p < 0.001) and colorectal (14 vs. 23 months, p = 0.003), but not in ovarian tumors (32 vs. 42 months, p = 0.893), whereas median PCI did not differ among subgroups. CONCLUSIONS DR during CRS/HIPEC does not increase morbidity and mortality. It is associated with worse survival in appendiceal and colorectal tumors, even after adjusting for tumor burden but does not appear to impact ovarian cancer survival.
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Affiliation(s)
- Andrei Nikiforchin
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 Saint Paul Place, Baltimore, MD, 21202, USA
| | - Vadim Gushchin
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 Saint Paul Place, Baltimore, MD, 21202, USA
| | - Michelle Sittig
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 Saint Paul Place, Baltimore, MD, 21202, USA
| | - Ekaterina Baron
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 Saint Paul Place, Baltimore, MD, 21202, USA
| | - Felipe Lopez-Ramirez
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 Saint Paul Place, Baltimore, MD, 21202, USA
| | - Carol Nieroda
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 Saint Paul Place, Baltimore, MD, 21202, USA
| | - Armando Sardi
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 Saint Paul Place, Baltimore, MD, 21202, USA.
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Nikiforchin A, Sittig M, Gushchin V, Sardi A. ASO Author Reflections: What to Expect After You Resect Diaphragm During CRS/HIPEC. Ann Surg Oncol 2021; 29:883-884. [PMID: 34537898 DOI: 10.1245/s10434-021-10824-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/04/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Andrei Nikiforchin
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Michelle Sittig
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Vadim Gushchin
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Armando Sardi
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA.
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Nikiforchin A, Gushchin V, King MC, Baron E, Lopez-Ramirez F, Sardi A. Cytoreductive Surgery with Hyperthermic Intrathoracic Chemotherapy for Patients with Intrapleural Dissemination of Peritoneal Surface Malignancies. Ann Surg Oncol 2021; 28:9126-9135. [PMID: 34263367 DOI: 10.1245/s10434-021-10298-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/24/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Peritoneal surface malignancies (PSM) can disseminate into the pleural cavity, increasing morbidity and mortality. While cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS/HIPEC) improves outcomes for PSM with intra-abdominal spread, the optimal approach for patients with pleural dissemination from PSM remains unclear. It seems reasonable to apply peritoneal carcinomatosis management principles to patients with pleural lesions using CRS and hyperthermic intrathoracic chemotherapy (HITHOC). METHODS We conducted a descriptive study to evaluate outcomes of PSM patients who underwent CRS/HITHOC for pleural dissemination using a high-volume PSM center's prospective database from October 1994-June 2020. CRS/HITHOC was performed via either diaphragmatic window during CRS/HIPEC (CRS/HIPEC+HITHOC) or thoracotomy as a separate procedure (CRS/HITHOC). RESULTS Of 852 completed CRS/HIPECs, 18 HITHOCs in 15 patients were identified: 10 CRS/HIPEC+HITHOCs, and 8 CRS/HITHOCs. CRS/HIPEC+HITHOC primary tumors included: 4 appendix, 4 ovary, 1 colon, and 1 unknown. All (n = 8) CRS/HITHOC patients had recurrent appendiceal neoplasms. Complete cytoreduction was achieved in 90% of CRS/HIPEC+HITHOCs and 75% of CRS/HITHOCs. Major complications occurred in 20% of CRS/HIPEC+HITHOCs and 13% of CRS/HITHOCs with no 30-day mortality in either group. After median follow-up of 22 months, overall survival at 1, 3, and 5 years was 93.3%, 67.9%, and 67.9%, while 1-, 3-, and 5-year progression-free survival was 70.9%, 20.3%, and 20.3%. Intrapleural recurrence occurred in 1 CRS/HIPEC+HITHOC and 2 CRS/HITHOC patients. CONCLUSIONS CRS/HITHOC performed via diaphragm or thoracotomy at high-volume centers is a safe option for PSM with pleural dissemination. Further comparative studies with longer follow-up are needed to evaluate survival by tumor type.
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Affiliation(s)
- Andrei Nikiforchin
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Vadim Gushchin
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Mary Caitlin King
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Ekaterina Baron
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Felipe Lopez-Ramirez
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Armando Sardi
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA.
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Segura-Sampedro JJ, Craus-Miguel A, González-Argenté X, Morales-Soriano R. ASO Author Reflections: Diaphragmatic Resection Often Is Needed in CRS/HIPEC But Does Not Increase Respiratory Complications. Ann Surg Oncol 2021; 28:4683-4684. [PMID: 33423125 DOI: 10.1245/s10434-020-09530-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Juan José Segura-Sampedro
- General and Digestive Surgery Department, University Hospital Son Espases, Palma de Mallorca, Spain. .,Health Research Institute of Balearic Islands, Palma de Mallorca, Spain. .,School of Medicine, University of Balearic Islands, Palma de Mallorca, Spain.
| | - Andrea Craus-Miguel
- General and Digestive Surgery Department, University Hospital Son Espases, Palma de Mallorca, Spain.,Health Research Institute of Balearic Islands, Palma de Mallorca, Spain
| | - Xavier González-Argenté
- General and Digestive Surgery Department, University Hospital Son Espases, Palma de Mallorca, Spain.,Health Research Institute of Balearic Islands, Palma de Mallorca, Spain.,School of Medicine, University of Balearic Islands, Palma de Mallorca, Spain
| | - Rafael Morales-Soriano
- General and Digestive Surgery Department, University Hospital Son Espases, Palma de Mallorca, Spain.,Health Research Institute of Balearic Islands, Palma de Mallorca, Spain
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Craus-Miguel A, Segura-Sampedro JJ, González-Argenté X, Morales-Soriano R. Diaphragmatic Peritonectomy and Full-Thickness Resection in CRS/HIPEC May Allow Higher Completeness of Cytoreduction Rates with a Low Rate of Respiratory Complications. Ann Surg Oncol 2021; 28:4676-4682. [PMID: 33409735 DOI: 10.1245/s10434-020-09505-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/01/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cytoreductive surgery (CRS) provides a survival benefit when achieved without residual disease. As diaphragm is frequently affected in peritoneal malignancies, complete cytoreduction often requires surgical techniques over the diaphragm. The purpose of the study was to assess diaphragmatic resection impact on cytoreduction completeness, morbidity and mortality compared to less aggressive diaphragmatic peritonectomy in CRS and hyperthermic intraperitoneal chemotherapy (HIPEC) settings. MATERIALS AND METHODS Patients with peritoneal carcinomatosis and supramesocolic disease undergoing CRS/HIPEC from 2011 to 2019 were included in a prospectively collected database. We compared patients who underwent full-thickness diaphragmatic resection (DR) and diaphragmatic peritonectomy (DP). Epidemiological and clinical data, morbidity, and mortality within 90 days of surgery were documented. RESULTS 232 patients were initially selected. Inclusion criteria were met by 88 procedures. DR was performed on 32 patients and DP on 56. Number of resected organs was 5.21 in the DR cohort vs. 3.57 in the DP cohort (p<0.0001). Rate of Peritoneal Cancer Index (PCI) score >14 was higher in the DR group (75%) than in the DP group (50.9%) (p=0.027). Tumor invasion of diaphragmatic muscle after DR was confirmed in 89.3% patients. Postoperative pleural effusion was observed in 28 patients (50%) in the DP group and in 17 (53.1%) in the DR group. CONCLUSIONS CRS/HIPEC requires specific surgical techniques over the diaphragm to achieve complete cytoreduction. As diaphragmatic muscle invasion is frequent, full-thickness resection may allow a cytoreduction completeness increase without an increased morbidity. Pleural drains are not systematically required as these procedures show low incidence of major respiratory complications.
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Affiliation(s)
- Andrea Craus-Miguel
- General and Digestive Surgery Department, University Hospital Son Espases, Palma De Mallorca, Spain.,Health Research Institute of Balearic Islands, Palma De Mallorca, Spain
| | - Juan José Segura-Sampedro
- General and Digestive Surgery Department, University Hospital Son Espases, Palma De Mallorca, Spain. .,Health Research Institute of Balearic Islands, Palma De Mallorca, Spain. .,School of Medicine, University of Balearic Islands, Palma De Mallorca, Spain.
| | - Xavier González-Argenté
- General and Digestive Surgery Department, University Hospital Son Espases, Palma De Mallorca, Spain.,Health Research Institute of Balearic Islands, Palma De Mallorca, Spain.,School of Medicine, University of Balearic Islands, Palma De Mallorca, Spain
| | - Rafael Morales-Soriano
- General and Digestive Surgery Department, University Hospital Son Espases, Palma De Mallorca, Spain.,Health Research Institute of Balearic Islands, Palma De Mallorca, Spain
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Feasibility of diaphragmatic interventions in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis: A 20-year experience. Eur J Surg Oncol 2020; 47:143-148. [PMID: 32888734 DOI: 10.1016/j.ejso.2020.08.016] [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: 03/11/2020] [Revised: 07/28/2020] [Accepted: 08/20/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Complete cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is an effective treatment for improving prognosis of selected patients with peritoneal carcinomatosis. The addiction of diaphragmatic procedures may increase the incidence of postoperative respiratory complications. Our goal was to evaluate the early postoperative results following diaphragmatic surgery. METHODS Prospectively collected data of patients undergoing diaphragmatic surgery between January 2000 and January 2020 were retrospectively analyzed. Chest drains were routinely placed in all cases. Demographics, clinical and perioperative features were evaluated. RESULTS The study included 222 patients. Peritoneal stripping and full-thickness resections were performed in 165 and 57 cases, respectively. Women and ovarian tumours represented the vast majority of cases. Overall postoperative mortality and morbidity rates were 1.3% (3 patients) and 43.2% (96 patients), respectively. Specific diaphragmatic surgery-related complications was 9.4% (21 patients). No pleural effusion and pneumothotrax occurred. The incidence of pneumonia was 1.8% (4 patients), each due to systemic bacterial origin, 2 (0.9%) of which required Intensive Care Unit-readmission. Postoperative bleeding was observed in 15 (6.7%) cases, 12 (5.4%) of which required reoperation. A comparison with 105 patients who operated during the same period without diaphragmatic surgery was performed and by multivariate analysis, Peritoneal Cancer Index, histology and overall morbidity resulted significantly associated with diaphragmatic surgery. CONCLUSION Diaphragmatic surgery during cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is often required in order to obtain complete resection. It may be associated with higher postoperative morbidity, especially bleeding, but routine placement of chest drains may reduce the incidence of adverse respiratory events.
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11
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Carboni F, Valle M. Letter to Sullivan BJ et al. "Diaphragmatic Peritoneal Stripping Versus Full-Thickness Resection in CRS/HIPEC: Is There a Difference?". Ann Surg Oncol 2019; 26:871. [PMID: 31691108 DOI: 10.1245/s10434-019-07949-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Fabio Carboni
- Department of Digestive Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
| | - Mario Valle
- Department of Digestive Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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