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Do certain surgical steps increase postoperative morbidity after cytoreductive surgery and HIPEC- a retrospective analysis. Surg Oncol 2022; 45:101884. [DOI: 10.1016/j.suronc.2022.101884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/20/2022] [Accepted: 10/31/2022] [Indexed: 11/07/2022]
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Roux A, David V, Bardet M S, Auditeau E, Durand Fontanier S, Taibi A. Predictive value of C-reactive protein levels for the early and later detection of postoperative complications after cytoreductive surgery and HIPEC. Front Oncol 2022; 12:943522. [DOI: 10.3389/fonc.2022.943522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
SynopsisC-reactive protein (CRP), white blood cells and procalcitonin (PCT) participate in the systemic response to inflammation and increase after postoperative infective complications. Postoperative complications after CRS and HIPEC could be predicted using the CRP cut-off value (169 mg/L at PODs 3-5 and 62 mg/L at PODs 7-10).BackgroundPostoperative elevation of C-reactive protein (CRP) can be used in order to predict the postoperative complications in many indications. Cytoreduction surgery (CRS) associated with hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with high morbidity.ObjectivesThe aim of the study was to demonstrate the CRP predictive value for the occurrence of complications.MethodsAll patients who had CRS and HIPEC, regardless of the origin of peritoneal metastasis, were included in this retrospective study. Postoperative complications and CRP and white blood cell (WBC) counts were recorded from postoperative day (POD) 1 through 10.ResultsAmong the 127 patients included, 58 (45.7%) had no complications (NCs), 53 (41.7%) had infective complications (ICs), and 16 (12.6%) had non-infective complications (NICs). The IC group had a higher CRP value than the NC group, which was statistically significant from POD7 to POD10 (41.1 versus 107.5 p = 0.023 and 77.8 versus 140 p = 0.047, respectively). A cut-off CRP value was 169 mg/L at PODs 3-5 and 62 mg/L at PODs 7-10. The area under the curve (AUC) at POD5 was 0.56 versus 0.76 at POD7, p=0.007. The sensibility, specificity, positive and negative predictive values of these cut-offs were 55%, 83%, 74% and 67%, respectively. Moreover, 17 patients (32%) with ICs had a CRP value higher than these cut-offs before the diagnosis was made by the medical team.ConclusionThis study suggested that postoperative complications could be predicted using the CRP cut-off value on PODs 3-5 (169 mg/l) and PODs 7-10 (62 mg/l) after CRS and HIPEC.
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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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Verd Rodríguez M, Esteve Pérez N, Morales Soriano R, Fabián González D. Quick diagnosis of pleural effusion secondary to chemotherapy infusion during cytorreductive surgery and hyperthermic intraperitoneal chemotherapy. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:123-124. [PMID: 35183470 DOI: 10.1016/j.redare.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 06/14/2023]
Affiliation(s)
- M Verd Rodríguez
- Departamento de Anestesiología, Hospital Universitario Son Espases, Palma, Balearic Islands, Spain.
| | - N Esteve Pérez
- Departamento de Anestesiología, Hospital Universitario Son Espases, Palma, Balearic Islands, Spain
| | - R Morales Soriano
- Departamento de Anestesiología, Hospital Universitario Son Espases, Palma, Balearic Islands, Spain
| | - D Fabián González
- Departamento de Anestesiología, Hospital Universitario Son Espases, Palma, Balearic Islands, Spain
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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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Verd Rodríguez M, Esteve Pérez N, Morales Soriano R, Fabián González D. Quick diagnosis of pleural effusion secondary to chemotherapy infusion during cytorreductive surgery and hyperthermic intraperitoneal chemotherapy. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 69:S0034-9356(21)00114-6. [PMID: 34544598 DOI: 10.1016/j.redar.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 11/26/2022]
Affiliation(s)
- M Verd Rodríguez
- Departamento de Anestesiología, Hospital Universitario Son Espases, Palma, Islas Baleares, España.
| | - N Esteve Pérez
- Departamento de Anestesiología, Hospital Universitario Son Espases, Palma, Islas Baleares, España
| | - R Morales Soriano
- Departamento de Anestesiología, Hospital Universitario Son Espases, Palma, Islas Baleares, España
| | - D Fabián González
- Departamento de Anestesiología, Hospital Universitario Son Espases, Palma, Islas Baleares, España
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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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