BACKGROUND AND OBJECTIVES: Maximal cytoreductive surgery (CS) with heated intraperitoneal chemotherapy perfusion (HIPEC) for peritoneal carcinomatosis can improve oncologic outcomes, but is associated with significant morbidity. Whether low-volume experience with CS/HIPEC results in acceptable outcomes is unknown. METHODS: A retrospective review of all patients undergoing CS/HIPEC by a single surgeon. Experience was divided into first versus second 50 cases, and patient characteristics, operative details, and outcomes were compared. RESULTS: Ninety patients underwent 100 CS/HIPEC procedures (mean age 57 years, 68% female). -Compared to the initial experience, the second 50 cases included more high grade tumors (68 vs. 52%) and greater disease burden (PCI 14.2 vs. 12.4). Operative times remained unchanged and mean blood loss decreased (978 vs. 684 ml). Hospital stay (mean 18.1 vs. 12.6 days), major complications (24 vs. 16%), and perioperative mortality (8 vs. 2%) declined. Overall median survival was 18 months and was longer with low grade tumors (26 vs. 16 months, P = 0.03). CONCLUSIONS: Patients experienced reduced EBL, fewer major complications, and shorter hospital stay, despite having higher disease burden and higher grade tumors. This suggests that even low-volume experience with CS/HIPEC can lead to a trend in reduction of adverse perioperative events with acceptable oncologic outcomes.
BACKGROUND AND OBJECTIVES: Maximal cytoreductive surgery (CS) with heated intraperitoneal chemotherapy perfusion (HIPEC) for peritoneal carcinomatosis can improve oncologic outcomes, but is associated with significant morbidity. Whether low-volume experience with CS/HIPEC results in acceptable outcomes is unknown. METHODS: A retrospective review of all patients undergoing CS/HIPEC by a single surgeon. Experience was divided into first versus second 50 cases, and patient characteristics, operative details, and outcomes were compared. RESULTS: Ninety patients underwent 100 CS/HIPEC procedures (mean age 57 years, 68% female). -Compared to the initial experience, the second 50 cases included more high grade tumors (68 vs. 52%) and greater disease burden (PCI 14.2 vs. 12.4). Operative times remained unchanged and mean blood loss decreased (978 vs. 684 ml). Hospital stay (mean 18.1 vs. 12.6 days), major complications (24 vs. 16%), and perioperative mortality (8 vs. 2%) declined. Overall median survival was 18 months and was longer with low grade tumors (26 vs. 16 months, P = 0.03). CONCLUSIONS:Patients experienced reduced EBL, fewer major complications, and shorter hospital stay, despite having higher disease burden and higher grade tumors. This suggests that even low-volume experience with CS/HIPEC can lead to a trend in reduction of adverse perioperative events with acceptable oncologic outcomes.
Authors: Patricio M Polanco; Ying Ding; Jordan M Knox; Lekshmi Ramalingam; Heather Jones; Melissa E Hogg; Amer H Zureikat; Matthew P Holtzman; James Pingpank; Steven Ahrendt; Herbert J Zeh; David L Bartlett; Haroon A Choudry Journal: Ann Surg Oncol Date: 2014-11-07 Impact factor: 5.344
Authors: Robert F Bradley; John H Stewart; Gregory B Russell; Edward A Levine; Kim R Geisinger Journal: Am J Surg Pathol Date: 2006-05 Impact factor: 6.394
Authors: S van Ruth; Y I Z Acherman; M J van de Vijver; A A M Hart; V J Verwaal; F A N Zoetmulder Journal: Eur J Surg Oncol Date: 2003-10 Impact factor: 4.424
Authors: Andrew L Feldman; Steven K Libutti; James F Pingpank; David L Bartlett; Tatiana H Beresnev; Sharon M Mavroukakis; Seth M Steinberg; David J Liewehr; David E Kleiner; H Richard Alexander Journal: J Clin Oncol Date: 2003-12-15 Impact factor: 44.544
Authors: Edward A Levine; John H Stewart; Perry Shen; Gregory B Russell; Brian L Loggie; Konstantinos I Votanopoulos Journal: J Am Coll Surg Date: 2013-12-21 Impact factor: 6.113
Authors: Heon Jong Yoo; Jenny J Hong; Young Bok Ko; Mina Lee; Youjin Kim; Hye Young Han; Yong Jung Song; Myong Cheol Lim; Sang-Yoon Park Journal: World J Surg Oncol Date: 2018-05-15 Impact factor: 2.754