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Lario-Perez S, Macia JJ, Lillo-Garcia C, Caravaca I, Lopez-Rodriguez F, Calero A, Tomas-Rodriguez MI, Moya-Martinez A, Arroyo A, Lacueva FJ. Home-Based Trimodal Prehabilitation in Patients with Peritoneal Carcinomatosis Undergoing Cytoreductive Surgery: Effect on Functional Walking Capacity and Skeletal Muscle Mass. Ann Surg Oncol 2024:10.1245/s10434-024-15756-1. [PMID: 39012464 DOI: 10.1245/s10434-024-15756-1] [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: 02/28/2024] [Accepted: 06/24/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Patients with peritoneal carcinomatosis often suffer from loss of skeletal muscle mass and require extensive surgery. Multimodal prehabilitation may improve physical status but its benefits for these specific patients remain unknown. This study aimed to evaluate the effect of prehabilitation on functional walking capacity and skeletal muscle mass, as well as its association with postoperative complications. PATIENTS AND METHODS A prospective study of patients with peritoneal carcinomatosis following a home-based trimodal prehabilitation program was carried out. Functional walking capacity was assessed with the 6-min walk test (T6MWT), and by the appendicular skeletal muscle index (ASMI) estimated by bioelectrical impedance analysis. Data were collected at the first medical appointment and on the day before surgery. A 90-day postoperative morbidity was registered according to the Clavien-Dindo classification. RESULTS A total of 62 patients were included in the analysis. Women were more prevalent (77.4%) and peritoneal metastasis from ovarian origin accounted for 48.4%. Clavien II-V grades occurred in 30 (57.7%) patients. After prehabilitation, functional walking capacity improved by 42.2 m (39.62-44.72 m) compared with baseline data (p < 0.001), but no improvement was observed in the ASMI (p = 0.301). Patients able to walk at least 360 m after prehabilitation suffered fewer Clavien-Dindo II-V postoperative complications (p = 0.016). A T6MWT of less than 360 m was identified as an independent risk factor in the multivariable analysis (OR 3.99; 1.01-15.79 p = 0.048). CONCLUSIONS This home-based trimodal prehabilitation program improved functional walking capacity but not ASMI scores in patients with peritoneal metastasis before surgery. A T6MWT of less than 360 m was found to be a risk factor for postoperative complications.
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Affiliation(s)
- S Lario-Perez
- Oncological Abdominal and Pelvic Surgery Unit, General Surgery Department, University General Hospital of Elche, Elche, Spain
| | - J-J Macia
- Oncological Abdominal and Pelvic Surgery Unit, General Surgery Department, University General Hospital of Elche, Elche, Spain
| | - C Lillo-Garcia
- Oncological Abdominal and Pelvic Surgery Unit, General Surgery Department, University General Hospital of Elche, Elche, Spain
| | - I Caravaca
- Oncological Abdominal and Pelvic Surgery Unit, General Surgery Department, University General Hospital of Elche, Elche, Spain
| | - F Lopez-Rodriguez
- Colorectal Unit, General Surgery Department, University General Hospital of Elche, Elche, Spain
- Department of Pathology and Surgery, Miguel Hernández University, San Juan de Alicante, Alicante, Spain
| | - A Calero
- Oncological Abdominal and Pelvic Surgery Unit, General Surgery Department, University General Hospital of Elche, Elche, Spain
- Department of Pathology and Surgery, Miguel Hernández University, San Juan de Alicante, Alicante, Spain
| | - M I Tomas-Rodriguez
- Center for Translational Research in Physiotherapy, Pathology and Surgery Department, Miguel Hernandez University of Elche, Elche, Spain
- Department of Pathology and Surgery, Miguel Hernández University, San Juan de Alicante, Alicante, Spain
| | - A Moya-Martinez
- Statistical Department, FISABIO, University General Hospital of Elche, Elche, Spain
| | - A Arroyo
- Colorectal Unit, General Surgery Department, University General Hospital of Elche, Elche, Spain
- Department of Pathology and Surgery, Miguel Hernández University, San Juan de Alicante, Alicante, Spain
| | - F-J Lacueva
- Oncological Abdominal and Pelvic Surgery Unit, General Surgery Department, University General Hospital of Elche, Elche, Spain.
- Department of Pathology and Surgery, Miguel Hernández University, San Juan de Alicante, Alicante, Spain.
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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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3
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Durán-Martínez M, Gómez-Dueñas G, Rodriguez-Ortíz L, Sanchez-Hidalgo JM, Suárez AG, Casado-Adam Á, Rufián-Peña S, Andujar BR, Valenzuela-Molina F, Vázquez-Borrego MC, Romero-Ruiz A, Briceño-Delgado J, Arjona-Sánchez Á. Learning curve for minimal invasive cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) procedures. Langenbecks Arch Surg 2023; 408:146. [PMID: 37046100 DOI: 10.1007/s00423-023-02882-9] [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: 01/04/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE The benefits of the minimally invasive approach for performing cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (L-CRS + HIPEC) have been described previously, associating an early recovery with similar oncologic outcomes in patients with limited peritoneal carcinomatosis. Currently, no studies are focusing on the learning curve for this emerging procedure. This study aimed to evaluate the L-CRS + HIPEC learning curve and its knock-on effect on the perioperative outcomes. METHODS We identified all consecutive unselected patients who underwent L-CRS + HIPEC by a single surgeon between April 2016 and January 2022 (n = 51). Patients who underwent risk-reducing CRS + HIPEC (PCI = 0) or initial conversion due to an intraoperative PCI > 10 were excluded from the final analysis. To evaluate the learning curve, perioperative data were analysed using the cumulative sum (CUSUM) analysis. RESULTS Twenty-six patients were included in the final analysis. Major morbidity occurred in one patient (3.8%). The difficulty of the L-CRS + HIPEC procedures was categorised as low in 23.1% (n = 6), intermediate in 19.2% (n = 5), and advanced in 57.7% (n = 15). The mean length of hospital stay was 5.4 ± 1.5 days. No patient had a conversion to open surgery. The learning curve was divided into two distinct phases: the learning phase (1-14) and the consolidation phase (15-26). A significant decrease in the operative time (375 ± 103.1 vs 239.2 ± 63.6 min) was observed with no differences in complexity, the number of peritonectomy procedures, or morbidity. CONCLUSION L-CRS + HIPEC is a complex procedure that must be performed in a high-volume and experienced oncologic unit, requiring a learning curve to achieve the consolidation condition, which could be established after 14 procedures.
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Affiliation(s)
| | | | - Lidia Rodriguez-Ortíz
- Unit of Surgical Oncology, University Hospital Reina Sofia, Cordoba, Spain
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Menendez Pidal Av 14004, Cordova, Spain
| | - Juan Manuel Sanchez-Hidalgo
- Unit of Surgical Oncology, University Hospital Reina Sofia, Cordoba, Spain
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Menendez Pidal Av 14004, Cordova, Spain
| | - Antonio Gordon Suárez
- Unit of Surgical Oncology, University Hospital Reina Sofia, Cordoba, Spain
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Menendez Pidal Av 14004, Cordova, Spain
| | - Ángela Casado-Adam
- Unit of Surgical Oncology, University Hospital Reina Sofia, Cordoba, Spain
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Menendez Pidal Av 14004, Cordova, Spain
| | - Sebastián Rufián-Peña
- Unit of Surgical Oncology, University Hospital Reina Sofia, Cordoba, Spain
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Menendez Pidal Av 14004, Cordova, Spain
| | - Blanca Rufián Andujar
- Unit of Surgical Oncology, University Hospital Reina Sofia, Cordoba, Spain
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Menendez Pidal Av 14004, Cordova, Spain
| | - Francisca Valenzuela-Molina
- Unit of Surgical Oncology, University Hospital Reina Sofia, Cordoba, Spain
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Menendez Pidal Av 14004, Cordova, Spain
| | - María Carmen Vázquez-Borrego
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Menendez Pidal Av 14004, Cordova, Spain
| | - Antonio Romero-Ruiz
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Menendez Pidal Av 14004, Cordova, Spain
| | | | - Álvaro Arjona-Sánchez
- Unit of Surgical Oncology, University Hospital Reina Sofia, Cordoba, Spain.
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Menendez Pidal Av 14004, Cordova, Spain.
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Mor E, Assaf D, Laks S, Gilat EK, Hazzan D, Shacham-Shmueli E, Margalit O, Halpern N, Beller T, Boursi B, Purim O, Perelson D, Zippel D, Adileh M, Nissan A, Ben-Yaacov A. Pelvic Peritonectomy Poorly Affects Outcomes in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Metastases. J Gastrointest Surg 2023; 27:131-140. [PMID: 36327025 DOI: 10.1007/s11605-022-05501-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Constraints of pelvic anatomy render complete cytoreduction (CRS) challenging. The aim of this study is to investigate the impact of pelvic peritonectomy during CRS/HIPEC on colorectal peritoneal metastasis (CRPM) patients' outcomes. METHODS This is a retrospective analysis of a prospectively maintained CRS/hyperthermic intraperitoneal chemotherapy (HIPEC) database. The analysis included 217 patients with CRPM who had a CRS/HIPEC between 2014 and 2021. We compared perioperative and oncological outcomes of patients with pelvic peritonectomy (PP) (n = 63) to no pelvic peritonectomy (non-PP) (n = 154). RESULTS No differences in demographics were identified. The peritoneal cancer index (PCI) was higher in the PP group with a median PCI of 12 vs. 6 in the non-PP group (p < 0.001). Operative time was 4.9 vs. 4.3 h in the PP and non-PP groups, respectively (p = 0.63). Median hospitalization was longer in the PP group at 12 vs. 10 days (p = 0.007), and the rate of complications were higher in the PP group at 57.1% vs. 39.6% (p = 0.018). Pelvic peritonectomy was associated with worse disease-free (DFS) and overall survival (OS) with 3-year DFS and OS of 7.3 and 46.3% in the PP group vs. 28.2 and 87.8% in the non-PP group (p = 0.028, p .> 0.001). The univariate OS analysis identified higher PCI (p = 0.05), longer surgery duration (p = 0.02), and pelvic peritonectomy (p < 0.001) with worse OS. Pelvic peritonectomy remained an independent prognostic variable, irrespective of PCI, on the multivariate analysis (p < 0.001). CONCLUSIONS Pelvic peritonectomy at the time of CRS/HIPEC is associated with higher morbidity and worse oncological outcomes. These findings should be taken into consideration in the management of patients with pelvic involvement.
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Affiliation(s)
- Eyal Mor
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Dan Assaf
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Shachar Laks
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Efrat Keren Gilat
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - David Hazzan
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Einat Shacham-Shmueli
- Department of Oncology, Sheba Medical Center, Affiliated With The Sackler School of Medicine, Tel Aviv, University, Tel Hashomer, Israel
| | - Ofer Margalit
- Department of Oncology, Sheba Medical Center, Affiliated With The Sackler School of Medicine, Tel Aviv, University, Tel Hashomer, Israel
| | - Naama Halpern
- Department of Oncology, Sheba Medical Center, Affiliated With The Sackler School of Medicine, Tel Aviv, University, Tel Hashomer, Israel
| | - Tamar Beller
- Department of Oncology, Sheba Medical Center, Affiliated With The Sackler School of Medicine, Tel Aviv, University, Tel Hashomer, Israel
| | - Ben Boursi
- Department of Oncology, Sheba Medical Center, Affiliated With The Sackler School of Medicine, Tel Aviv, University, Tel Hashomer, Israel
| | - Ofer Purim
- Department of Oncology, Assuta Ashdod Public Hospital, Ashdod, Israel, Affiliated With Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel
| | - Daria Perelson
- Department of Anesthesiology, Sheba Medical Center, Affiliated With Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Douglas Zippel
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Mohammad Adileh
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Aviram Nissan
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Almog Ben-Yaacov
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel.
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5
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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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6
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Fernández-Candela A, Calero A, Sánchez-Guillén L, Escrig-Sos J, Barreras JA, López-Rodríguez-Arias F, Armañanzas L, Murcia A, Arroyo A, Lacueva FJ. Effect of Preoperative Immunonutrition on Postoperative Major Morbidity after Cytoreductive Surgery and HIPEC in Patients with Peritoneal Metastasis. Nutrients 2021; 13:2147. [PMID: 34201458 PMCID: PMC8308234 DOI: 10.3390/nu13072147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/08/2021] [Accepted: 06/21/2021] [Indexed: 12/26/2022] Open
Abstract
The effect of preoperative immunonutrition intake on postoperative major complications in patients following cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) was assessed. The accuracy of C-Reactive Protein (CRP) for detecting postoperative complications was also analyzed. Patients treated within a peritoneal carcinomatosis program in which a complete or optimal cytoreduction was achieved were retrospectively analyzed. They were divided into two groups based on whether preoperative immunonutrition (IMN) or not (non-IMN) were administered. Clinical and surgical variables and postoperative complications were gathered. Predictive values of major morbidity of CRP during the first 3 postoperative days (POD) were also evaluated. A total of 107 patients were included, 48 belonging to the IMN group and 59 to the non-IMN group. In multivariate analysis immunonutrition (OR 0.247; 95%CI 0.071-0.859; p = 0.028), and the number of visceral resections (OR 1.947; 95%CI 1.086-3.488; p = 0.025) emerged as independent factors associated with postoperative major morbidity. CRP values above 103 mg/L yielded a negative predictive value of 84%. Preoperative intake of immunonutrition was associated with a decrease of postoperative major morbidity and might be recommended to patients with peritoneal carcinomatosis following CRS. Measuring CRP levels during the 3 first postoperative days is useful to rule out major morbidity.
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Affiliation(s)
- Alba Fernández-Candela
- Peritoneal Carcinomatosis Unit, General Surgery Department, Elche University General Hospital, 03202 Elche, Spain; (A.F.-C.); (L.S.-G.); (J.A.B.); (F.L.-R.-A.); (L.A.); (A.A.); (F.J.L.)
| | - Alicia Calero
- Peritoneal Carcinomatosis Unit, General Surgery Department, Elche University General Hospital, 03202 Elche, Spain; (A.F.-C.); (L.S.-G.); (J.A.B.); (F.L.-R.-A.); (L.A.); (A.A.); (F.J.L.)
| | - Luís Sánchez-Guillén
- Peritoneal Carcinomatosis Unit, General Surgery Department, Elche University General Hospital, 03202 Elche, Spain; (A.F.-C.); (L.S.-G.); (J.A.B.); (F.L.-R.-A.); (L.A.); (A.A.); (F.J.L.)
| | - Javier Escrig-Sos
- Department of Medicine, University Jaume I (UJI), 12004 Valencia, Spain;
| | - José A. Barreras
- Peritoneal Carcinomatosis Unit, General Surgery Department, Elche University General Hospital, 03202 Elche, Spain; (A.F.-C.); (L.S.-G.); (J.A.B.); (F.L.-R.-A.); (L.A.); (A.A.); (F.J.L.)
| | - Francisco López-Rodríguez-Arias
- Peritoneal Carcinomatosis Unit, General Surgery Department, Elche University General Hospital, 03202 Elche, Spain; (A.F.-C.); (L.S.-G.); (J.A.B.); (F.L.-R.-A.); (L.A.); (A.A.); (F.J.L.)
| | - Laura Armañanzas
- Peritoneal Carcinomatosis Unit, General Surgery Department, Elche University General Hospital, 03202 Elche, Spain; (A.F.-C.); (L.S.-G.); (J.A.B.); (F.L.-R.-A.); (L.A.); (A.A.); (F.J.L.)
- Pathology and Surgery Department, Universidad Miguel Hernandez, 03202 Elche, Spain
| | - Ana Murcia
- Pharmacy Department, Elche University General Hospital, 03202 Elche, Spain;
| | - Antonio Arroyo
- Peritoneal Carcinomatosis Unit, General Surgery Department, Elche University General Hospital, 03202 Elche, Spain; (A.F.-C.); (L.S.-G.); (J.A.B.); (F.L.-R.-A.); (L.A.); (A.A.); (F.J.L.)
- Pathology and Surgery Department, Universidad Miguel Hernandez, 03202 Elche, Spain
| | - Francisco Javier Lacueva
- Peritoneal Carcinomatosis Unit, General Surgery Department, Elche University General Hospital, 03202 Elche, Spain; (A.F.-C.); (L.S.-G.); (J.A.B.); (F.L.-R.-A.); (L.A.); (A.A.); (F.J.L.)
- Pathology and Surgery Department, Universidad Miguel Hernandez, 03202 Elche, Spain
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7
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Mulens-Arias V, Nicolás-Boluda A, Pinto A, Balfourier A, Carn F, Silva AKA, Pocard M, Gazeau F. Tumor-Selective Immune-Active Mild Hyperthermia Associated with Chemotherapy in Colon Peritoneal Metastasis by Photoactivation of Fluorouracil-Gold Nanoparticle Complexes. ACS NANO 2021; 15:3330-3348. [PMID: 33528985 DOI: 10.1021/acsnano.0c10276] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Peritoneal metastasis (PM) is considered as the terminal stage of metastatic colon cancer, with still poor median survival rate even with the best recent chemotherapy treatment. The current PM treatment combines cytoreductive surgery, which consists of resecting all macroscopic tumors, with hyperthermic intraperitoneal chemotherapy (HIPEC), which uses mild hyperthermia to boost the diffusion and cytotoxic effect of chemotherapeutic drugs. As HIPEC is performed via a closed circulation of a hot liquid containing chemotherapy, it induces uncontrolled heating and drug distribution in the whole peritoneal cavity with important off-site toxicity and a high level of morbidity. Here, we propose a safer precision strategy using near-infrared (NIR) photoactivated gold nanoparticles (AuNPs) coupled to the chemotherapeutic drug 5-fluorouracil (5-FU) to enable a spatial and temporal control of mild chemo-hyperthermia targeted to the tumor nodules within the peritoneal cavity. Both the 16 nm AuNPs and the corresponding complex with 5-FU (AuNP-5-FU) were shown as efficient NIR photothermal agents in the microenvironment of subcutaneous colon tumors as well as PM in syngeneic mice. Noteworthy, NIR photothermia provided additional antitumor effects to 5-FU treatment. A single intraperitoneal administration of AuNP-5-FU resulted in their preferential accumulation in tumor nodules and peritoneal macrophages, allowing light-induced selective hyperthermia, extended tumor necrosis, and activation of a pro-inflammatory immune response while leaving healthy tissues without any damage. From a translational standpoint, the combined and tumor-targeted photothermal and chemotherapy mediated by the AuNP-drug complex has the potential to overcome the current off-target toxicity of HIPEC in clinical practice.
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Affiliation(s)
- Vladimir Mulens-Arias
- Université de Paris, Laboratoire MSC Matière et Systèmes Complexes, CNRS UMR 7057, 10 Rue Alice Domon et Léonie Duquet, 75205 Cedex 13 Paris, France
- Department of Immunology and Oncology, National Center for Biotechnology/CSIC, Darwin 3, Cantoblanco Campus, 28049 Madrid, Spain
| | - Alba Nicolás-Boluda
- Université de Paris, Laboratoire MSC Matière et Systèmes Complexes, CNRS UMR 7057, 10 Rue Alice Domon et Léonie Duquet, 75205 Cedex 13 Paris, France
| | - Amandine Pinto
- Université de Paris, UMR 1275 CAP Paris-Tech, F-75010 Paris, France
- Service de chirurgie digestive et cancérologique, Hôpital Lariboisière, 2 rue Ambroise Paré, F-75010 Paris, France
| | - Alice Balfourier
- Université de Paris, Laboratoire MSC Matière et Systèmes Complexes, CNRS UMR 7057, 10 Rue Alice Domon et Léonie Duquet, 75205 Cedex 13 Paris, France
| | - Florent Carn
- Université de Paris, Laboratoire MSC Matière et Systèmes Complexes, CNRS UMR 7057, 10 Rue Alice Domon et Léonie Duquet, 75205 Cedex 13 Paris, France
| | - Amanda K A Silva
- Université de Paris, Laboratoire MSC Matière et Systèmes Complexes, CNRS UMR 7057, 10 Rue Alice Domon et Léonie Duquet, 75205 Cedex 13 Paris, France
| | - Marc Pocard
- Université de Paris, UMR 1275 CAP Paris-Tech, F-75010 Paris, France
- Service de chirurgie digestive et cancérologique, Hôpital Lariboisière, 2 rue Ambroise Paré, F-75010 Paris, France
| | - Florence Gazeau
- Université de Paris, Laboratoire MSC Matière et Systèmes Complexes, CNRS UMR 7057, 10 Rue Alice Domon et Léonie Duquet, 75205 Cedex 13 Paris, France
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8
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Kamada Y, Hida K, Ishibashi H, Sako S, Mizumoto A, Ichinose M, Padmanabhan N, Yoshida S, Yonemura Y. Thirty-three long-term survivors after cytoreductive surgery in patients with peritoneal metastases from colorectal cancer: a retrospective descriptive study. World J Surg Oncol 2021; 19:31. [PMID: 33509224 PMCID: PMC7845127 DOI: 10.1186/s12957-021-02145-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/20/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) improves survival in selected patients with peritoneal metastasis (PM) from colorectal cancer (CRC). However, little has been reported on characteristics and clinical course of long-term survivors with CRC-PM beyond 5 years. The objective of this study was to identify the clinical and oncological features affecting long-term survival of CRC-PM after comprehensive treatment. METHODS Between January 1990 and April 2015, CRC-PM patients who underwent CRS with or without HIPEC in two Japanese tertiary hospitals were analyzed. Clinicopathological parameters and therapeutic details for long-term survivors (patients surviving ≥ 5 years after CRS) were described and compared with those for non-survivors (patients surviving < 5 years). RESULTS The study identified 236 patients with CRC-PM who underwent CRS, with a median follow-up period of 2.5 years. Thirty-three patients (14.0%) were considered as long-term survivors. Compared with non-survivors, long-term survivors had a lower median peritoneal cancer index (PCI) [4 (1-27) vs 9 (0-39), p < 0.001]. Complete cytoreduction (CCR-0) was achieved in all long-term survivors, with a significantly higher rate [33/33 (100%) vs 141/203 (69.8%), p < 0.001]. Metachronous onsets of PM were more frequently observed in the long-term survivor group [26/33 (78.8%) vs 103/203 (50.3%), p = 0.018]. Regarding histopathology, long-term survivors more frequently had mucinous adenocarcinoma than non-survivors [8/33 (24.2%) vs 27/203 (13.3%)] and less likely exhibited poorly differentiated or signet ring cell carcinoma [2/33 (6.1%) vs 48/203 (23.7%)] (p < 0.001). CONCLUSIONS One in seven patients with CRC-PM achieved the long-term milestone after CRS. A long-term survival was associated with the presence of low PCI, CCR-0, metachronous onset, and mucinous histology.
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Affiliation(s)
- Yasuyuki Kamada
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54, Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, Japan. .,NPO to support Peritoneal Surface Malignancy Treatment, Japanese/Asian School of Peritoneal Surface Oncology, Kyoto, Japan. .,Department of Regional Cancer Therapy, Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kishiwada, Japan.
| | - Koya Hida
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54, Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, Japan
| | - Haruaki Ishibashi
- NPO to support Peritoneal Surface Malignancy Treatment, Japanese/Asian School of Peritoneal Surface Oncology, Kyoto, Japan.,Department of Regional Cancer Therapy, Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Shouzou Sako
- NPO to support Peritoneal Surface Malignancy Treatment, Japanese/Asian School of Peritoneal Surface Oncology, Kyoto, Japan.,Department of Regional Cancer Therapy, Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Akiyoshi Mizumoto
- Department of Regional Cancer Therapy, Peritoneal Surface Malignancy Center, Kusatsu General Hospital, Shiga, Japan
| | - Masumi Ichinose
- Department of Regional Cancer Therapy, Peritoneal Surface Malignancy Center, Kusatsu General Hospital, Shiga, Japan
| | - Naveen Padmanabhan
- Department of Regional Cancer Therapy, Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kishiwada, Japan.,Department of Surgical Oncology, Apollo Cancer Institute, Chennai, India
| | - Shinya Yoshida
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54, Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, Japan
| | - Yutaka Yonemura
- NPO to support Peritoneal Surface Malignancy Treatment, Japanese/Asian School of Peritoneal Surface Oncology, Kyoto, Japan.,Department of Regional Cancer Therapy, Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kishiwada, Japan.,Department of Regional Cancer Therapy, Peritoneal Surface Malignancy Center, Kusatsu General Hospital, Shiga, Japan
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9
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Rodriguez RR, Babar L, Lo H, Ashraf O, Monga D, Finley G, Doverspike L, Blackledge A, Sethi A, Raj MS. A Retrospective Analysis of Factors Affecting Palliative Care Consults in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Cureus 2021; 13:e12589. [PMID: 33575150 PMCID: PMC7870133 DOI: 10.7759/cureus.12589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose This study was conducted to determine factors that influence palliative care (PC) consultation in patients receiving cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Patient and methods We queried our Electronic Medical Record EPIC for a list of patients who underwent cytoreductive surgery with HIPEC or hyperthermic intrathoracic chemotherapy (HITEC) in the hospital from April 2016-April 2019. Data was manually extracted and patients who did not meet our criteria were excluded. Patients were divided on the basis of palliative care consults and differences between the groups were analyzed. Odds ratios (OR) with p-value of 0.05 and confidence interval of (CI) 95% were calculated. Results We identified 55 patients of whom 34 met our inclusion criteria: 11 males and 23 females with an average age of 56 years at the time of diagnosis. Eight patients (23%) had PC, with six having commercial insurance, seven married, and six with more than one comorbid medical issue. Comorbidities >1 (OR: 0.12; CI: 0.02-0.76; p: 0.02) and age >40 (OR: 0.015; CI: 0.0007-0.3029; P: 0.006) were associated with a higher likelihood of PC. Gender, insurance type, and marital status did not have a significant association with PC. Mean age between PC consulted patients versus non-PC consulted patients was 58.5 vs. 55.9 and median age between the two groups was 60.5 vs. 60 which also showed a trend towards higher rates of PC in the older population. Conclusion Approximately one quarter of patients who underwent CRS with HIPEC had a concurrent PC consult. Though this is better than the national average of 11-16%, it continues to be a very small number. Efforts must be made to engage PC early in the course of treatment and recognize it as an integral part of cancer care. PC is not only an end-of-life service, in fact, studies have shown that early consultations lead to higher patient satisfaction, improved quality of life, and better communication.
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Affiliation(s)
| | - Laila Babar
- Medical Oncology, The University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Herman Lo
- Medical Oncology, Allegheny Health Network, Pittsburgh, USA
| | - Obaid Ashraf
- Internal Medicine, Allegheny Health Network, Pittsburgh, USA
| | - Dulabh Monga
- Hematology and Oncology, Allegheny Health Network, Pittsburgh, USA
| | - Gene Finley
- Hematology and Oncology, Allegheny Health Network, Pittsburgh, USA
| | | | | | - Ashish Sethi
- Medical Oncology, Allegheny Health Network, Pittsburgh, USA
| | - Moses S Raj
- Hematology and Oncology, Allegheny Health Network, Pittsburgh, USA
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10
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Balakrishnan K, Srinivasaraghavan N, Venketeswaran MV, Ramasamy T, Seshadri RA, Raj EH. Perioperative factors predicting delayed enteral resumption and hospital length of stay in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: Retrospective cohort analysis from a single centre in India. Indian J Anaesth 2020; 64:1025-1031. [PMID: 33542565 PMCID: PMC7852446 DOI: 10.4103/ija.ija_480_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/13/2020] [Accepted: 09/27/2020] [Indexed: 12/19/2022] Open
Abstract
Background and Aims: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is an extensive procedure associated with significant morbidity, delay in return of gastrointestinal function and discharge from hospital. Our aim was to assess perioperative factors influencing enteral resumption (ER) and length of stay in the hospital (LOS) in CRS-HIPEC. Methods: A retrospective analysis was conducted in a major tertiary cancer centre. Sixty-five patients who underwent CRS-HIPEC between July 2014 and March 2019 were included in the study. The perioperative data were collected from patient records. The primary outcome measure was day of oral resumption of 500 ml of clear fluids and secondary outcome was the LOS. Univariate and multivariate logistic regression analysis was done for the various continuous and categorical perioperative variables for both ER and LOS to elicit the magnitude of risk for both outcomes. Results: Univariate logistic regression revealed that peritoneal carcinomatosis index score (PCI), duration of surgery, blood loss and postoperative ventilation influenced both ER and LOS. Serum albumin, plasma usage and total peritonectomy affected only the LOS but not ER. Multivariate analysis showed that duration of surgery (P = 0.006) and quantum of intravenous fluid infused (P = 0.043) were statistically associated with ER, while serum albumin level (P = 0.025) and postoperative ventilation (P = 0.045) were independently predictive of LOS. Conclusion: CRS-HIPEC is an extensive surgery and multiple factors are associated with ER; of these, duration of surgery and intraoperative fluid therapy are significant factors. Low serum albumin and prolonged postoperative ventilation are associated with increased LOS.
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Affiliation(s)
- Kalpana Balakrishnan
- Department of Anaesthesiology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | | | | | - Thendral Ramasamy
- Department of Anaesthesiology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | | | - E Hemanth Raj
- Department of Surgical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
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11
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Nandi R, Das S, Nag A, Datta A. Jaundice after cytoreductive surgery along with hyperthermic intra-peritoneal chemotherapy in an ovarian cancer patient: A case report. Indian J Anaesth 2020; 64:997-999. [PMID: 33487694 PMCID: PMC7815011 DOI: 10.4103/ija.ija_418_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/08/2020] [Accepted: 05/17/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Rudranil Nandi
- Department of Oncoanaesthesia, Critical Care and Palliative Medicine, Netaji Subhash Chandra Bose Cancer Hospital, Kolkata, West Bengal, India
| | - Soumen Das
- Department of Surgical Oncolgy, Netaji Subhash Chandra Bose Cancer Hospital, Kolkata, West Bengal, India
| | - Anirban Nag
- Department of Surgical Oncolgy, Netaji Subhash Chandra Bose Cancer Hospital, Kolkata, West Bengal, India
| | - Anupam Datta
- Department of Clinical Oncology, Netaji Subhash Chandra Bose Cancer Hospital, Kolkata, West Bengal, India
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12
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Burg ML, Yamzon J, Li WY. Full thickness penile skin necrosis following HIPEC: Case report and literature review. Urol Case Rep 2020; 34:101430. [PMID: 33088716 PMCID: PMC7558780 DOI: 10.1016/j.eucr.2020.101430] [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: 09/15/2020] [Accepted: 09/27/2020] [Indexed: 11/04/2022] Open
Abstract
Heated intraperitoneal chemotherapy (HIPEC) is commonly performed at the time of tumor resection for metastatic intraabdominal tumors. Post operative complications, such as superficial wound infections or bowel leaks are common. They are largely thought to be secondary to poor wound healing due to chemotherapy-associated neutropenia. Scrotal eschars resulting in full-thickness skin necrosis have rarely been reported as a delayed complication after HIPEC. Here, we present the first case report of penile full-thickness skin necrosis after abdominal cytoreduction with HIPEC combined with ventral hernia repair and mesh placement.
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Affiliation(s)
- Madeleine L Burg
- Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave., Suite 7416, Los Angeles, CA, 90089, USA
| | - Jonathan Yamzon
- Division of Urology, City of Hope National Medical Center, 1500 E. Duarte Rd., Duarte, CA, 91010, USA
| | - Wai-Yee Li
- Division of Plastic and Reconstructive Surgery, City of Hope National Medical Center, 1500 E. Duarte Rd., Duarte, CA, 91010, USA
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13
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Solanki SL, Jhingan MAK, Saklani AP. Rebound hypothermia after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) and cardiac arrest in immediate postoperative period: a report of two cases and review of literature. Pleura Peritoneum 2020; 5:20200126. [PMID: 33364341 PMCID: PMC7746889 DOI: 10.1515/pp-2020-0126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/29/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy (CRS-HIPEC) for peritoneal malignancies are complex surgeries marked with hemodynamic perturbations, temperature fluctuations, blood loss and metabolic disturbances in the intra-operative and post-operative period. In this report, we highlighted perioperative factors which may have led to cardiac arrest in immediate postoperative period and subsequent successful resuscitation in two patients with high volume peritoneal cancers who underwent CRS-HIPEC. CASE PRESENTATION Both patients had a similar clinical course, characterized by massive blood and fluid loss, metabolic derangement, hemodynamic instability, long duration of surgery, post HIPEC rebound hypothermia and hypokalemia which need to be anticipated. CONCLUSIONS We reviewed the literature related to postoperative hypothermia and other major complications after CRS-HIPEC and correlated the available literature with our findings.
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Affiliation(s)
- Sohan Lal Solanki
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Mrida A. K. Jhingan
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Avanish P. Saklani
- Gastro-Intestinal Services, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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14
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Rouche A, Hübner M, Grass F, Pache B, Demartines N, Blanc C. Anaesthesia in a Toxic Environment: Pressurised Intraperitoneal Aerosol Chemotherapy: A Retrospective Analysis. Turk J Anaesthesiol Reanim 2020; 48:273-279. [PMID: 32864641 PMCID: PMC7434348 DOI: 10.5152/tjar.2019.15493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 08/27/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Pressurised intraperitoneal aerosol chemotherapy (PIPAC) is a new type of intraperitoneal chemotherapy for peritoneal carcinosis via minimally invasive surgery. This technique's specificity is the remote application of the therapy because of the potential risk of exposure to toxic products. The present paper summarises the important aspects of PIPAC and analyses the anaesthetic outcomes. METHODS This retrospective study included all patients undergoing PIPAC treatment between January 2015 and February 2018. Data on protocol adherence and perioperative anaesthetic complications and postoperative nausea and vomiting (PONV) and pain levels (visual analogue scale 0-10) from recovery room to 72 h were analysed. RESULTS The overall analysis included 193 PIPAC procedures on 87 patients. Protocol adherence was high as regards the use of propofol (100%), rocuronium (98%), antiemetic prophylaxis (99%) and lidocaine intravenous (i.v.) (87%). No accidental exposure to chemotherapy occurred during the study period. Of the 87 patients, 6.3% suffered delayed recovery, 58% due to hypothermia and 42% due to excessive sedation or curarisation. In the recovery room, 16% of patients suffered moderate to severe pain, requiring >8 mg of morphine i.v., with average doses of 13.7 mg. Median postoperative pain scores were 1 and 3 at 12 h and 0 and 0 at 72 h at rest and mobilisation, respectively. PONV was observed in <10% of patients during the first 12 h, but in 40% at 72 h. CONCLUSION A dedicated anaesthetic protocol and intraoperative safety checklist facilitates safe, well-tolerated anaesthesia for PIPAC treatments.
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Affiliation(s)
- Amir Rouche
- Department of Anaesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Fabian Grass
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Basile Pache
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Catherine Blanc
- Department of Anaesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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15
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Li T, Yu J, Chen Y, Liu R, Li Y, Wang YX, Wang JJ, Zhu P. Preventive intraperitoneal hyperthermic perfusion chemotherapy for patients with T4 stage colon adenocarcinoma. Tech Coloproctol 2020; 25:683-691. [PMID: 32572664 DOI: 10.1007/s10151-020-02270-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 06/14/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to be an effective treatment for peritoneal tumors; whether preventive HIPEC after radical resection for T4 stage colon adenocarcinoma could decrease peritoneal recurrence remains unknown. The aim of the present study was to compare peritoneal recurrence and short-term survival in patients with T4 stage colon adenocarcinoma undergoing HIPEC plus adjuvant chemotherapy or adjuvant chemotherapy alone following surgery. METHODS We retrospectively reviewed T4 stage colon adenocarcinoma patients who had radical tumor resection at our institution between January 2014 and January 2019. Clinical data were extracted from the database at our institution, and patient survival and long-term complications were assessed through repeated outpatient examinations and telephone interviews. RESULTS A total of 352 patients were included in this study; 157 patients received postoperative HIPEC plus adjuvant chemotherapy (HIPEC group), 195 patients received adjuvant chemotherapy alone (conventional chemotherapy group). Forty-one (26.1%) patients in the HIPEC group had a peritoneal recurrence and the peritoneum was the first site of tumor recurrence in 6 (14.6%) of them. However, 73 (37.4%) patients experienced peritoneal recurrence in the conventional group, and the peritoneum was the first site of tumor recurrence in 25 (34.2%) (p = 0.019). Disease-free survival in the HIPEC group at 1 and 3 years was 93.3% and 61.1%, respectively, versus 89.3% and 51.7% in the conventional chemotherapy group (p = 0.038). Overall survival in the HIPEC group at 1 and 3 years was 100.0% and 82.7%, respectively, versus 100.0% and 76.9% in the conventional chemotherapy group (p = 0.420). The two groups did not differ with respect to severe complications. CONCLUSIONS Preventive HIPEC after radical surgery may decrease peritoneal recurrence and promote disease-free survival for T4 stage colon adenocarcinoma. Large-scale randomized controlled studies are needed to confirm the results of our study.
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Affiliation(s)
- T Li
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, China
| | - J Yu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, China
| | - Y Chen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, China
| | - R Liu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, China
| | - Y Li
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, China
| | - Y X Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, China
| | - J J Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, China
| | - P Zhu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, China.
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16
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Elgendy H, Nafady-Hego H, Abd Elmoneim HM, Youssef T, Alzahrani A. Perioperative management and postoperative outcome of patients undergoing cytoreduction surgery with hyperthermic intraperitoneal chemotherapy. Indian J Anaesth 2019; 63:805-813. [PMID: 31649392 PMCID: PMC6798638 DOI: 10.4103/ija.ija_324_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/03/2019] [Accepted: 07/27/2019] [Indexed: 11/04/2022] Open
Abstract
Background and Aims The existence of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) as a multidisciplinary approach for peritoneal cancer gains acceptance in many countries including Saudi Arabia. The aim of our study is to describe the perioperative management of patients who received CRS/HIPEC and to report their outcomes and complications at our tertiary centre. Methods The preoperative characteristics, surgical variables, perioperative management, postoperative course and outcomes of 38 CRS/HIPEC patients were prospectively collected and analysed. Results The mean age of our patients was 52 years, and 23 (60.5%) of them were females. The overall postoperative mortality was 42.1%. Univariate analyses of risk factors for deaths after HIPEC demonstrated that low preoperative (haemoglobin, potassium, calcium and albumin), high (tumour marker (CA19.9), intraoperative transfusion of human plasma protein (HPP), colloids, postoperative activated partial thromboplastin time and bacterial infections were potential risk factors for patient's mortality. Multivariate analysis of those variables demonstrated that low preoperative calcium [hazard ratio (HR) = 0.116; 95% confidence interval (CI) = 0.033-0.407; P = 0.001], high intraoperative HPP transfusion (HR = 1.004; 95% CI = 1.001-1.003; P = 0.012) and presence of postoperative bacterial infection (HR = 5.987; 95% CI = 1.009-35.54; P = 0.049) were independent predictors of patient's death. Seventy morbidities happened after HIPEC; only bacterial infection independently predicted postoperative mortality. Conclusion To improve postoperative outcome of CRS/HIPEC, optimisation of transfusion, temperature, electrolytes and using broader-spectrum prophylaxis to manage postoperative infections should be warranted.
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Affiliation(s)
- Hamed Elgendy
- Department of Anaesthesia, Faculty of Medicine, Assiut University, Assiut, Egypt.,Department of Anaesthesia, King Abdullah Medical City, Mecca, Saudi Arabia.,Department of Anaesthesia, HAMAD Medical Corporation and Weill Cornell Medicine, Doha, Qatar
| | - Hanaa Nafady-Hego
- Department of Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.,Division of Translational Medicine, Sidra Medical and Research Center, Doha, Qatar
| | - Hanan M Abd Elmoneim
- Department of Pathology, Faculty of Medicine, Minia University, Minia, Egypt.,Department of Pathology, Faculty of Medicine, Umm Alqura University, Mecca, Saudi Arabia
| | - Talha Youssef
- Department of Internal Medicine, Prince Mohammad Bin Abdul-Aziz Hospital, Ministry of National Guard, Al Madinah, Saudi Arabia
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17
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Sánchez-Hidalgo JM, Rodríguez-Ortiz L, Arjona-Sánchez Á, Rufián-Peña S, Casado-Adam Á, Cosano-Álvarez A, Briceño-Delgado J. Colorectal peritoneal metastases: Optimal management review. World J Gastroenterol 2019; 25:3484-3502. [PMID: 31367152 PMCID: PMC6658395 DOI: 10.3748/wjg.v25.i27.3484] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/20/2019] [Accepted: 06/23/2019] [Indexed: 02/06/2023] Open
Abstract
The peritoneum is a common site of dissemination for colorrectal cancer, with a poorer prognosis than other sites of metastases. In the last two decades, it has been considered as a locoregional disease progression and treated as such with curative intention treatments. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is the actual reference treatment for these patients as better survival results have been reached as compared to systemic chemotherapy alone, but its therapeutic efficacy is still under debate. Actual guidelines recommend that the management of colorectal cancer with peritoneal metastases should be led by a multidisciplinary team carried out in experienced centers and consider CRS + HIPEC for selected patients. Accumulative evidence in the last three years suggests that this is a curative treatment that may improve patients disease-free survival, decrease the risk of recurrence, and does not increase the risk of treatment-related mortality. In this review we aim to gather the latest results from referral centers and opinions from experts about the effectiveness and feasibility of CRS + HIPEC for treating peritoneal disease from colorectal malignancies.
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Affiliation(s)
| | - Lidia Rodríguez-Ortiz
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba 14004, Spain
| | - Álvaro Arjona-Sánchez
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba 14004, Spain
| | - Sebastián Rufián-Peña
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba 14004, Spain
| | - Ángela Casado-Adam
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba 14004, Spain
| | - Antonio Cosano-Álvarez
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba 14004, Spain
| | - Javier Briceño-Delgado
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba 14004, Spain
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18
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Aldawoodi NN, Escher AR, Ninan D, Patel SY. Transesophageal Echocardiography During Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy: A Novel Approach. Cureus 2019; 11:e5062. [PMID: 31328075 PMCID: PMC6624119 DOI: 10.7759/cureus.5062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is an extensive, lengthy procedure for patients with peritoneal metastases. It is associated with fairly high morbidity and mortality as compared with other non-vascular intra-abdominal surgeries. Fluid and hemodynamic management is challenging and not well established, particularly in patients with a low ejection fraction (EF). This case details the successful intraoperative anesthetic management of a patient with an ejection fraction of 20% undergoing CRS/HIPEC using the addition of intraoperative transesophageal echocardiography (TEE) as an adjunct to central venous pressure (CVP), urine output (UOP), and calculated stroke volume variation (SVV) for goal-directed resuscitation and blood pressure support.
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Affiliation(s)
- Nasrin N Aldawoodi
- Anesthesiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| | - Allan R Escher
- Anesthesiology / Pain Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| | - David Ninan
- Anesthesiology, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Sephalie Y Patel
- Anesthesiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
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19
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Sleeman JP. PIPAC puts pressure on peritoneal metastases from pancreatic cancer. Clin Exp Metastasis 2019; 34:291-293. [PMID: 28593512 DOI: 10.1007/s10585-017-9851-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Jonathan P Sleeman
- Medical Faculty Mannheim, Centre for Biomedicine and Medical Technology Mannheim (CBTM), University of Heidelberg, TRIDOMUS-Gebäude Haus C, Ludolf-Krehl-Str. 13 - 17, 68167, Mannheim, Germany. .,Karlsruhe Institute for Technology (KIT), Campus Nord, Institut für Toxikologie und Genetik, Postfach 3640, 76021, Karlsruhe, Germany.
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20
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de Witte P, de Witt CA, van de Minkelis JL, Boerma D, Solinger HF, Hack CE, Bruins P. Inflammatory response and optimalisation of perioperative fluid administration during hyperthermic intraoperative intraperitoneal chemotherapy surgery. J Gastrointest Oncol 2019; 10:244-253. [PMID: 31032091 DOI: 10.21037/jgo.2018.12.09] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Surgical cytoreduction and simultaneous hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis has a high incidence of postoperative complications. Inadequate intraoperative volume therapy is a known risk factor for the development of postoperative complications. Another possible risk factor is the inflammatory response due to surgery and HIPEC. The aim of this observational pilot study was to monitor fluid intake in the first 24 hours peri- and postoperative by using a non-invasive cardiac output indicator. Furthermore, we measured circulating cytokines and evaluated the possible relation of these changes of inflammatory response with the non-invasive monitored fluid management. Methods Twenty-four patients undergoing cytoreductive surgery and HIPEC for peritoneal carcinomatosis were included. Patients were randomised into either a liberal fluid management group using intra-arterial blood pressure and central venous pressure measurement or a restrictive group by using intra-arterial blood pressure and central venous pressure measurement with FloTrac/Vigileo monitoring. Cytokines were measured with multiplex immunoassays. Results We found no difference in the amount of fluid administration in patients undergoing HIPEC surgery with FloTrac/Vigileo monitoring compared to standard care. Furthermore, there was no difference in mortality, ICU and hospital length of stay between both groups. A severe inflammatory response was seen in all patients after the HIPEC procedure with a rapid increase of interleukins and C-reactive protein (CRP). There was however no difference between our intervention and control group in the severity of this reaction. Finally, we found no relation between the severity of the inflammatory response and mortality, or a composite end-point of mortality and severe complications within 30 days postoperative. Conclusions FloTrac/Vigileo monitoring does not lead to a more restrictive fluid administration and does not influence short-term clinical course in patients undergoing HIPEC surgery. The procedure itself leads to a severe inflammatory response, which is not affected by the use of FloTrac/Vigileo. Our data do not support the use of FloTrac/Vigileo monitoring in patients undergoing HIPEC surgery concerning fluid restrictive management.
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Affiliation(s)
- Piet de Witte
- Department of Anesthesiology, Intensive Care & Pain Management, St Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - Christien A de Witt
- Department of Anesthesiology & Pain Management, Medisch Centrum, Alkmaar, The Netherlands
| | - Johan L van de Minkelis
- Department of Anesthesiology & Pain Management, Elisabeth-TweeSteden ziekenhuis, Tilburg, The Netherlands
| | - Djamila Boerma
- Department of Surgery, St Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - H Frank Solinger
- Department of Extracorporeal Circulation, St Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - C Erik Hack
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Rheumatology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Dermatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter Bruins
- Department of Anesthesiology, Intensive Care & Pain Management, St Antonius Ziekenhuis, Nieuwegein, The Netherlands
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21
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Sinukumar S, Mehta S, As R, Damodaran D, Ray M, Zaveri S, Kammar P, Bhatt A. Analysis of Clinical Outcomes of Pseudomyxoma Peritonei from Appendicular Origin Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy-A Retrospective Study from INDEPSO. Indian J Surg Oncol 2019; 10:65-70. [PMID: 30886496 DOI: 10.1007/s13193-018-00870-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 12/27/2018] [Indexed: 12/17/2022] Open
Abstract
To evaluate the clinical outcomes of patients of pseudomyxoma peritonei of appendiceal origin undergoing cytoreductive surgery and HIPEC. Data collected from members, an independent collaborative group of Indian surgeons specializing in the management of peritoneal surface malignancy (INDEPSO), was analyzed retrospectively. Clinicopathological and perioperative outcomes of patients treated for pseudomyxoma peritonei (PMP) of appendicular origin were evaluated. Ninety-one patients were diagnosed with pseudomyxoma peritonei of appendicular origin between March 2013 and December 2017. The median age was 53 years and 60% were females. The median PCI was 27 [range 3-39] and a CC-0/1 resection was achieved in 83.5% patients. The most common histological grade was low-grade PMP, seen in 71.4% cases. The overall rate of grades 3-4 morbidity was 33% (30/91) and the 90-day mortality rate reported was 6.5%. Pulmonary complications and systemic sepsis emerged as the most significant factors affecting morbidity, mortality, and failure to rescue. At a median follow-up of 24 months, the median OS was not reached and the median PFS was 53 months. On univariate and multivariate analysis, high-grade histology, prior chemotherapy, debulking surgery alone without HIPEC, and high PCI > 10 were predictors of poor progression-free survival. The survival and morbidity results of pseudomyxoma peritonei from appendicular origin following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy are encouraging. With further awareness and understanding of the disease, and improvement in surgical expertise and learning curve, there is scope for further reduction in morbidity and better improvement in survival.
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Affiliation(s)
- Snita Sinukumar
- 1Department of Surgical Oncology, Jehangir hospital, 32, Sassoon Road, Pune, Maharashtra 411001 India
| | - Sanket Mehta
- 2Department of Peritoneal Surface Oncology, Saifee Hospital, Mumbai, India
| | - Ramakrishnan As
- 3Department of Surgical Oncology, Cancer Institute (WIA), Chennai, India
| | - Dileep Damodaran
- Department of Surgical Oncology, MVR Cancer Center and Research Institute, Calicut, India
| | - Mukurdipi Ray
- 5Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Shabber Zaveri
- 6Department of Surgical Oncology, Manipal Hospital, Bangalore, India
| | - Praveen Kammar
- 2Department of Peritoneal Surface Oncology, Saifee Hospital, Mumbai, India
| | - Aditi Bhatt
- Department of Surgical Oncology, Zydus Hospital, Ahmedabad, India
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22
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Arjona-Sanchez A, Rufian-Peña S, Sanchez-Hidalgo JM, Casado-Adam A, Cosano-Alvarez A, Briceño-Delgado J. Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy (HIPEC) by Minimally Invasive Approach, an Initial Experience. World J Surg 2018; 42:3120-3124. [PMID: 29691625 DOI: 10.1007/s00268-018-4634-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The cytoreductive surgery (CRS) associated with hyperthermic intraperitoneal chemotherapy (HIPEC) has become the standard treatment in patients with carcinomatosis peritoneal from different origins. The use of a minimally invasive approach for this high complex procedure might be an alternative that provides them less morbidity and faster recovery with similar oncologic outcomes. METHODS We describe the initial experience of CRS and HIPEC done via the laparoscopic route in patients with minimal peritoneal metastases in our Unit from March 2016 to January 2018. RESULTS A total of eight patients were operated by this minimally invasive approach. The different diagnoses were low-grade pseudomyxoma peritonei (2), benign multicystic mesothelioma (2), primary epithelial ovarian carcinomatosis (2) and locally advanced colon carcinoma T4 (2). The median age was 54 (20-62) years, the median PCI was 3 (2-4), the median operative time was 287 min (240-360), complete cytoreduction CC0 was achieved in all the patients, and no major morbidity was observed. The median length of stay was 4.75 days (4-5). After a median follow-up of 9.5 months, no relapse has been observed. CONCLUSION The results suggest that this minimally invasive approach for CRS and HIPEC is feasible and safe in a highly selected group of patients with peritoneal surface malignancies.
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Affiliation(s)
- A Arjona-Sanchez
- Unit of Oncologic and Pancreatic Surgery, University Hospital Reina Sofía, Menendez Pidal, 14004, Córdoba, Spain.
- CIBERehd, IMIBIC, University Hospital Reina Sofía, Córdoba, Spain.
| | - S Rufian-Peña
- Unit of Oncologic and Pancreatic Surgery, University Hospital Reina Sofía, Menendez Pidal, 14004, Córdoba, Spain
- CIBERehd, IMIBIC, University Hospital Reina Sofía, Córdoba, Spain
| | - J M Sanchez-Hidalgo
- Unit of Oncologic and Pancreatic Surgery, University Hospital Reina Sofía, Menendez Pidal, 14004, Córdoba, Spain
- CIBERehd, IMIBIC, University Hospital Reina Sofía, Córdoba, Spain
| | - A Casado-Adam
- Unit of Oncologic and Pancreatic Surgery, University Hospital Reina Sofía, Menendez Pidal, 14004, Córdoba, Spain
- CIBERehd, IMIBIC, University Hospital Reina Sofía, Córdoba, Spain
| | - A Cosano-Alvarez
- Unit of Oncologic and Pancreatic Surgery, University Hospital Reina Sofía, Menendez Pidal, 14004, Córdoba, Spain
- CIBERehd, IMIBIC, University Hospital Reina Sofía, Córdoba, Spain
| | - J Briceño-Delgado
- Unit of Oncologic and Pancreatic Surgery, University Hospital Reina Sofía, Menendez Pidal, 14004, Córdoba, Spain
- CIBERehd, IMIBIC, University Hospital Reina Sofía, Córdoba, Spain
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23
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Mouw TJ, Lu J, Woody-Fowler M, Ashcraft J, Valentino J, DiPasco P, Mammen J, Al-Kasspooles M. Morbidity and mortality of synchronous hepatectomy with cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). J Gastrointest Oncol 2018; 9:828-832. [PMID: 30505581 DOI: 10.21037/jgo.2018.06.04] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background Liver resection in conjunction with partial colectomy for colon cancer is considered acceptable treatment for isolated metastasis to the liver. This method is unstudied in patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for carcinomatosis due to colon cancer and high grade appendiceal cancer. Methods A retrospective chart review included patients from 2005 to 2016 undergoing CRS/HIPEC. Cancers other than colorectal adenocarcinoma and high grade appendiceal carcinoma were excluded. Patients were divided into hepatectomy and non-hepatectomy groups. Data was collected by chart review from electronic medical records to assess morbidity and mortality, as well as oncologic outcomes of included patients. Results The average patient age, length of stay, and sex were similar between groups. For those in the hepatectomy group, 80% underwent minor hepatectomy, and 20% underwent major hepatectomy. The comprehensive complication index (CCI) scores ranged from 0 (no complications), to 100 (death). The average CCI between study groups was similar (27.29 vs. 17.41, P=0.09). Hepatectomy was associated with a higher rate of Clavien-Dindo classifications (CDCs) of III or greater. Complications included pressor requirement, renal failure, blood transfusions, TPN, pleural effusions and leaks requiring drain placement, respiratory failure, UTI, new onset atrial fibrillation, wound infections, and death. Conclusions Patients who underwent CRS/HIPEC and hepatectomy for colorectal and high grade appendiceal carcinomatosis had more severe complications at similar rates to non-hepatectomy patients. Complication rates should be considered when selecting patients for aggressive surgical intervention.
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Affiliation(s)
- Tyler J Mouw
- Department of Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jennifer Lu
- Department of Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Meghan Woody-Fowler
- Department of Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - John Ashcraft
- Department of Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Joseph Valentino
- Department of Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Peter DiPasco
- Department of Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Joshua Mammen
- Department of Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Mazin Al-Kasspooles
- Department of Surgery, University of Kansas Medical Center, Kansas City, KS, USA
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24
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Kuncewitch M, Levine EA, Shen P, Votanopoulos KI. The Role of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Appendiceal Tumors and Colorectal Adenocarcinomas. Clin Colon Rectal Surg 2018; 31:288-294. [PMID: 30186050 DOI: 10.1055/s-0038-1642052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Peritoneal surface disease (PSD) has historically been used interchangeably with the term peritoneal carcinomatosis (PC) and has a dismal natural history. A variety of malignant pathologies, including colorectal and appendiceal primary tumors, can disseminate throughout the peritoneal cavity, leading to bowel obstruction and death. In general, peritoneal spread from high-grade appendiceal and colorectal primaries has the potential of hepatic and distant spread and best classified as PC. Low-grade appendiceal tumors are better categorized as PSD, due to low cellularity, high mucin production, and lack of potential spread outside the peritoneal cavity. Growing international experience with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) over the past 30 years has presented a therapeutic option to patients with PSD from colorectal and appendiceal tumors that can provide significant disease control, as well as potential for previously unattainable long-term survival. The proliferation of HIPEC centers and ongoing prospective trials are helping to standardize HIPEC techniques and patient selection.
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Affiliation(s)
- Michael Kuncewitch
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Edward A Levine
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Perry Shen
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
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25
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A minimally invasive approach for peritonectomy procedures and hyperthermic intraperitoneal chemotherapy (HIPEC) in limited peritoneal carcinomatosis: The American Society of Peritoneal Surface Malignancies (ASPSM) multi-institution analysis. Surg Endosc 2018; 33:854-860. [PMID: 30003349 DOI: 10.1007/s00464-018-6352-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 07/06/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Minimally invasive surgery is playing an increasing role in the treatment of patients with gastrointestinal and gynaecological malignancies as the data show reduced morbidity, faster recovery and similar oncological outcome when compared to open procedures. MATERIALS AND METHODS The American Society of Peritoneal Surface Malignancies (ASPSM) conducted a retrospective study to analyse peritonectomy procedures and HIPEC done via the laparoscopic route. A database with standard clinical and pathological parameters was set up and distributed amongst ASPSM members. Rate of relapse, morbidity and mortality were the primary endpoints of the study. RESULTS A total of 90 patients from 7 centres around the world were identified. Sixty percent were female. Mean age was 50 years. Peritoneal carcinomatosis from appendiceal origin was the most common diagnosis in a 64.9% of patients and colon origin was diagnosed in 16.5% of patients. Mean peritoneal cancer index (PCI) was 4.1 (0-10). Forty-one percent of patients had a bowel resection. Mean operative time was 4.7 h (2.5-8). All patients had a complete cytoreduction and HIPEC. Grade 3 and 4 morbidity was 3.0 and 6.5%, respectively. The most common reason for re-operation was an internal hernia in 2 out of 5 cases. Operative mortality and re-admission rates were 0 and 5%, respectively. Mean hospital stay was 7.4 days (1-18). At a mean follow-up of 31.6 months, 15/90 patients have a disease relapse but loco-regional relapse was identified in only five patients. CONCLUSIONS Analysis of these data suggests that minimally invasive approach for peritonectomy procedures and HIPEC is feasible, safe and should be considered as part of the armamentarium for highly selected patients with peritoneal surface malignancies with limited tumour burden, defined as PCI of 10 or less and borderline tumours as low-grade pseudomyxoma and benign multicystic mesothelioma.
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26
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Van Poucke S, Huskens D, Van der Speeten K, Roest M, Lauwereins B, Zheng MH, Dehaene S, Penders J, Marcus A, Lancé M. Thrombin generation and platelet activation in cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy - A prospective cohort study. PLoS One 2018; 13:e0193657. [PMID: 29927924 PMCID: PMC6013150 DOI: 10.1371/journal.pone.0193657] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 02/15/2018] [Indexed: 12/20/2022] Open
Abstract
Background and objectives Cytoreductive surgery (CRS) with hyperthermic intraperitoneal peroperative chemotherapy (HIPEC), indicated for patients with peritoneal metastases from digestive or gynecological malignancies alike, demonstrates a considerable impact on hemostatic metabolism, both on platelet and on coagulation level. The potential hemostatic interference in CRS and HIPEC is phase dependent. The hypothesis of this prospective cohort study is that the procedure exposed an increased thrombotic risk, resulting in a faster and increased thrombin generation and hyper platelet function. Methods This study explores the combined use of ROTEM (rotational thromboelastometry), PACT (platelet activation test) and CAT (thrombin generation test) assays during CRS and HIPEC with a follow-up of 7 days postoperative in 27 patients with confirmed histological diagnosis of peritoneal disease. Results Platelet reactivity (relative to before incision values) to CRP (collagen-related peptide) (p value 0.02) and TRAP (thrombin receptor activator peptide) (p value 0.048) seems to be slightly reduced during CRS and HIPEC with regard to αIIbβ3 activation, while P-selectin expression is not affected. During surgery, CAT demonstrates that, the LT (lagtime) (p value 0.0003) and TTP (time-to-thrombin peak) values (p value 0.002) decrease while and the TP (thrombin peak) (p value 0.004) and ETP (endogenous thrombin potential) (p value 0.02) increase. Subsequently, after surgery, the LT and TTP increase and ETP and TP decrease in time. ROTEM EXTEM (extrinsic) MCF (maximum clot firmness) (p value 0.005), INTEM (intrinsic) MCF (p value 0.003) and FIBTEM (fibrinogen) MCF (p value <0.001) decreased during CRS. At day 7 INTEM and FIBTEM MCF values (p values of 0.004 and <0.001) were significantly higher than before surgery. No considerable changes in platelet count and hemoglobin concentration and absence of leukopenia are noticed. Conclusion This approach detects changes in coagulation much earlier than noticed by standard coagulation tests.
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Affiliation(s)
- Sven Van Poucke
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, ZOL, Genk, Belgium
- * E-mail:
| | - Dana Huskens
- Synapse Research Institute, Maastricht, The Netherlands
| | | | - Mark Roest
- Synapse Research Institute, Maastricht, The Netherlands
| | - Bart Lauwereins
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, ZOL, Genk, Belgium
| | - Ming-Hua Zheng
- Department of Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Seppe Dehaene
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, ZOL, Genk, Belgium
| | | | - Abraham Marcus
- Department of Anesthesiology, ICU and Perioperative Medicine,HMC, Doha,Qatar
| | - Marcus Lancé
- Department of Anesthesiology & Pain Treatment, Maastricht University Medical Centre, Maastricht, The Netherlands
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Roh WS, Lee S, Park JH, Kang J. Abdominal Sarcoidosis Mimicking Peritoneal Carcinomatosis. Ann Coloproctol 2018; 34:101-105. [PMID: 29742855 PMCID: PMC5951098 DOI: 10.3393/ac.2018.01.29] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 01/29/2018] [Indexed: 12/17/2022] Open
Abstract
We present a patient diagnosed with skin sarcoidosis, breast cancer, pulmonary tuberculosis, and peritoneal sarcoidosis with a past history of colorectal cancer. During stage work up for breast cancer, suspicious lesions on peritoneum were observed in imaging studies. Considering our patient’s history and imaging findings, we initially suspected peritoneal carcinomatosis. However, the peritoneal lesion was diagnosed as sarcoidosis in laparoscopic biopsy. This case demonstrates that abdominal sarcoidosis might be considered as a differential diagnosis when there is a lesion suspected of being peritoneal carcinomatosis with nontypical clinical presentations.
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Affiliation(s)
- Won Seok Roh
- Department of Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seungho Lee
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hyun Park
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jeonghyun Kang
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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28
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Garg R. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Fluid and temperature remain the culprit! Indian J Anaesth 2018; 62:162-165. [PMID: 29643548 PMCID: PMC5881316 DOI: 10.4103/ija.ija_170_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Rakesh Garg
- Department of Onco-Anaesthesiology and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, New Delhi, India E-mail:
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29
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Balakrishnan KP, Survesan S. Anaesthetic management and perioperative outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: A retrospective analysis. Indian J Anaesth 2018; 62:188-196. [PMID: 29643552 PMCID: PMC5881320 DOI: 10.4103/ija.ija_39_18] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background and Aims: Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is becoming the standard treatment option for peritoneal carcinomatosis but is associated with high rates of morbidity and mortality. Our aim was to retrospectively analyse and evaluate intra-operative factors associated with morbidity and mortality of CRS and HIPEC. Methods: Intra-operative data were collected for cases done over 1 year (24 cases) and analysed for the primary outcome of post-operative ventilation >24 h, and secondary outcome of length of the Intensive Care Unit (ICU) stay >5 days. Statistical analysis was carried out in STATA 11 software. Results: Higher peritoneal carcinoma index (PCI), (P = 0.0047), longer duration of surgery (P = 0.0016), higher delta temperatures (P = 0.0119), increased estimated blood loss (EBL) (P = 0.0054), high intraoperative fluid requirement (P = 0.0038), lower mean arterial pressure (MAP) (P = 0.0021) and higher blood products requirement were associated with >24 h ventilation. These factors were also associated with longer ICU stay. All these factors associated with >24 h ventilation and prolonged ICU stay are related to the PCI which is an indicator of the extent of surgery. Conclusion: Higher PCI, longer duration of surgery, higher delta temperatures, increased EBL, high intraoperative fluid requirement, lower mean arterial pressure and higher blood products requirement were associated with >24 h postoperative ventilation as well as ICU stay >5 days. All these factors are related to the PCI, which is a major predictor of post-operative morbidity.
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Affiliation(s)
- Kalpana P Balakrishnan
- Department of Anaesthesia, Regional Cancer Centre, Adyar Cancer Institute, Chennai, Tamil Nadu, India
| | - Sreedevi Survesan
- Department of Anaesthesia, Regional Cancer Centre, Adyar Cancer Institute, Chennai, Tamil Nadu, India
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30
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Luzzi L, Franchi F, Dapoto A, Ghisalberti M, Corzani R, Marrelli D, Marchetti L, Paladini P, Scolletta S. Hyperthermic intrathoracic chemotherapy after extended pleurectomy and decortication for malignant pleura mesothelioma: an observational study on outcome and microcirculatory changes. J Thorac Dis 2018; 10:S228-S236. [PMID: 29507790 DOI: 10.21037/jtd.2018.01.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background In the treatment of malignant pleural mesothelioma the Hyperthermic Intra THOracic Chemotherapy (HITHOC) can improve the efficacy of pleurectomy and decortication with a local cytotoxic effect. However its biological impact in patient's hemodynamic and microcirculatory changes were rarely investigated. Aim of this study is to describe our experience with HITHOC after pleurectomy and decortication evaluating the role of sublingual video-microscopy in assessing the microcirculatory changes in the perioperative period. Methods This is a prospective and observational study concerning 10 consecutive patients undergoing extended P/D followed by HITHOC. These patients underwent sublingual microcirculatory monitoring, which was adopted as a routine procedure since 2012. Haemodynamic parameters were collected at eight consecutive times: the day before surgery (T1), induction of anaesthesia (T2), surgical phase before HITHOC beginning (T3), 5 and 30 minutes after HITHOC start (T4 and T5, respectively), 5 minutes from HITHOC end (T6), after the admission in ICU (T7), at discharge from the ICU (T8). Cardiac output (CO) was calculated with MostCare. Systemic vascular resistance (SVR), oxygen delivery (DO2), and oxygen extraction rate (O2ER) were calculated using standard formulas. Arterial blood pressure and central venous pressure (CVP) were obtained with standard arterial and venous catheters. At the same times we assessed the sublingual microcirculation with Sidestream Dark Field technique. Results Hemodynamic and microcirculatory data were collected in 10 patients, 8 male and 2 females (mean age 68.6±9.0, and body surface area of 1.9±0.1 m2). All patients had arterial hypertension, and one patient had diabetes. The mean arterial pressure significantly decreased at T2, with respect to T1 (P=0.05). CO, CVP, DO2, O2ER, and ScvO2, did not change significantly over the time. All patients needed infusion of noradrenalin from T4 to T6. TVD significantly decreased from T1 to T3, T5, and T8. Similarly, PVD significantly decreased from T1 to T3 and T8, and MFI from T1 to T6 and T8. PPV and HI did not change over the study period. No correlation was found between hemodynamic parameters (MAP, CO, CVP, DO2, O2ER, ScvO2) and microcirculatory data (TVD, PVD, PPV, MFI, HI), at any time of the study. Conclusions In patients who receive HITHOC the fluid load can reduce the microvascular impairment restoring the normal tissue perfusion. This process takes days but is most evident in the first 72 h. The use of colloid and blood transfusion is much more effective in restoring microcirculation and reducing tissue damaging.
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Affiliation(s)
- Luca Luzzi
- Thoracic Surgery Unit, Department of Medicine, Surgery and Neuroscences, Siena University Hospital Siena, Italy
| | - Federico Franchi
- Unit of Anesthesia and Critical Care Medicine, Department of Medical Biotechnologies, Siena University Hospital, Siena, Italy
| | - Annarita Dapoto
- Unit of Anesthesia and Critical Care Medicine, Department of Medical Biotechnologies, Siena University Hospital, Siena, Italy
| | - Marco Ghisalberti
- Thoracic Surgery Unit, Department of Medicine, Surgery and Neuroscences, Siena University Hospital Siena, Italy
| | - Roberto Corzani
- Thoracic Surgery Unit, Department of Medicine, Surgery and Neuroscences, Siena University Hospital Siena, Italy
| | - Daniele Marrelli
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Luca Marchetti
- Unit of Cardiothoracic Surgery Postoperative Anesthesia, Department of Medicine, Surgery and Neuroscences, Siena University Hospital, Siena, Italy
| | - Piero Paladini
- Thoracic Surgery Unit, Department of Medicine, Surgery and Neuroscences, Siena University Hospital Siena, Italy
| | - Sabino Scolletta
- Unit of Anesthesia and Critical Care Medicine, Department of Medical Biotechnologies, Siena University Hospital, Siena, Italy
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Management of peritoneal surface malignancies in laparoscopic era: a concise review. INTERNATIONAL JOURNAL OF SURGERY-ONCOLOGY 2017; 1:e05. [PMID: 29177208 PMCID: PMC5673112 DOI: 10.1097/ij9.0000000000000005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 10/10/2016] [Indexed: 11/28/2022]
Abstract
Peritoneal carcinomatosis is seldom curable. Maximal cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy has been used in efforts to improve survival. There has been a recent explosion of interest in this modality of treatment with various centers employing its use throughout the world. This is a complex procedure associated with significant morbidity and mortality. This makes patient selection very critical and hence there has been immense interest in the evaluation of various prognostic indicators being evaluated. In addition, with the advent of minimally invasive surgery, laparoscopy is being increasingly utilized in different capacity. Newer indications for treatment and possible prevention of peritoneal carcinomatosis are being evaluated especially in colorectal cancer. The aim of this brief review is to synthesize and present the recent data available regarding the outcomes and evolving trends associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
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CRS and HIPEC for PMP-Use of the LC-CUSUM to Determine the Number of Procedures Required to Attain a Minimal Level of Proficiency in Delivering the Combined Modality Treatment. Indian J Surg Oncol 2017; 8:533-539. [PMID: 29203986 DOI: 10.1007/s13193-017-0692-8] [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] [Received: 12/13/2016] [Accepted: 08/07/2017] [Indexed: 01/02/2023] Open
Abstract
The learning curve for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for pseudomyxoma peritonei (PMP) which peaks at 90 procedures for the surgeon may take several years to reach. The cumulative summation (CUSUM) test of the learning curve (LC-CUSUM) was used to assess the safety of the procedure (minimal level of proficiency for the surgeon) in terms of morbidity, mortality, and completeness of cytoreduction and early oncological failure before the peak of the learning curve had been reached. The limits for h0 and h1 were set based on the results of large series of such cases published before. From 2011 to 2016, 77 patients with PMP underwent CRS and HIPEC. The mean peritoneal cancer index (PCI) was 28 and 75% of the patients had a CC-0/1 resection. The grade 3-4 morbidity was 42.6% and the mortality was 5.2%. The 5-year overall survival (OS) was 62.3% and the 3-year disease-free survival (DFS) was 71%. The LC-CUSUM analysis showed that for in-hospital mortality, acceptable limits are reached after the 57th case, after the 38th case for the grade 3-4 morbidity and CC-2/3 resections both and after the 70th case for early oncological failure. The number of cases required to attain a minimal level of proficiency for each prognostic variable is different. Using the CUSUM test, surgeons can analyze their performance and determine the areas in which they need to improve before the peak of the learning curve is reached. These outcomes reflect the performance of the multidisciplinary team and not the surgeon alone.
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Finlay B, Price T, Hewett P. Neutropenia and thrombocytopenia after cytoreductive surgery and heated intraperitoneal chemotherapy. Pleura Peritoneum 2017; 2:137-141. [PMID: 30911643 DOI: 10.1515/pp-2017-0008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 07/23/2017] [Indexed: 12/22/2022] Open
Abstract
Background Neutropenia and thrombocytopenia are well-recognised complications of systemic chemotherapy. In cytoreductive surgery and heated intraperitoneal chemotherapy (HIPEC), the interplay between surgical factors and systemic toxicity of chemotherapeutics must be considered when considering post-operative haematological outcomes. We sought to quantify the incidence of these events in cytoreductive surgery and HIPEC at our institution. Methods We conducted a single centre, a retrospective cohort study of 50 consecutive patients who underwent cytoreductive surgery and HIPEC from 2002 to 2015. Routine haematological data were analysed and complications classified according to CTCAE 4.0. Subgroup analysis was undertaken to compare those who received or not perioperative systemic chemotherapy. Results The rate of all-grade post-procedure neutropenia was 4 % (n=2/50); one grade 1, and one grade 4 neutropenia. The patient with grade 4 neutropenia died day 57 post-operatively, despite subsequent growth factor support. Eight percent (n=4/50) of patients had thrombocytopenia preoperatively. The overall rate of post-procedure thrombocytopenia was 46 % with grade 3-4 thrombocytopenia of 4 %. If not present preoperatively, thrombocytopenia onset was on day 1 or 2 post-operatively, with a median duration of 3 days. Conclusions Intraperitoneal delivery of chemotherapy as HIPEC can cause haematological toxicity with potentially fatal outcomes. However, the incidence of neutropenia and thrombocytopenia after CRS and HIPEC is low.
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Affiliation(s)
- Ben Finlay
- Department of Surgery, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South SA 5011, Australia
| | - Timothy Price
- Department of Haematology and Oncology and University of Adelaide, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Peter Hewett
- Department of Surgery, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South SA 5011, Australia
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Park DG. Is Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy a Safe and Effective Procedure for Treating Patients With a Peritoneal Surface Malignancy? Ann Coloproctol 2017; 33:3-4. [PMID: 28289655 PMCID: PMC5346779 DOI: 10.3393/ac.2017.33.1.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Dong-Guk Park
- Department of Surgery, Dankook University College of Medicine, Cheonan, Korea
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