Rachel M Lee1,2, Adriana C Gamboa1,2, Michael K Turgeon1,2, Mohammad Y Zaidi2,3, Charles Kimbrough2,4, Jennifer Leiting2,5, Travis Grotz2,6, Andrew J Lee2,7, Keith Fournier2,6, Benjamin Powers2,8,9, Sean Dineen2,8,9, Joel M Baumgartner2,10, Jula Veerapong2,10, Harveshp Mogal2,11, Callisia Clarke2,11, Gregory Wilson2,12, Sameer Patel2,12, Ryan Hendrix2,13, Laura Lambert2,14, Courtney Pokrzywa2,15, Daniel E Abbott2,15, Christopher J LaRocca2,16, Mustafa Raoof2,16, Jonathan Greer2, Fabian M Johnston2,17, Charles A Staley1,2, Jordan M Cloyd2,4, Shishir K Maithel1,2, Maria C Russell1,2. 1. Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA. 2. Department of Surgery, Division of Surgical Oncology, University of Minnesota, Minneapolis, Minnesota, USA. 3. Department of Surgery, Indiana University, Indianapolis, Indiana, USA. 4. Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA. 5. Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic , Rochester, Minnesota, USA. 6. Department of Surgery, Division of Gastrointestinal Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. 7. Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA. 8. Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida, USA. 9. Department of Oncologic Sciences, Morsani College of Medicine, Tampa, Florida, USA. 10. Department of Surgery, Division of Surgical Oncology, University of California, San Diego, California, USA. 11. Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. 12. Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA. 13. Department of Surgical Oncology, Health Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA. 14. Department of Surgery, Division of Surgical Oncology, University of Massachusetts Medical School, Worcester, Massachusetts, USA. 15. Department of Surgery, Division of Surgical Oncology, University of Wisconsin, Madison, Wisconsin, USA. 16. Department of Surgery, Division of Surgical Oncology, Johns Hopkins University, Baltimore, Maryland, USA. 17. Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA.
Abstract
BACKGROUND: While parenchymal hepatic metastases were previously considered a contraindication to cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC), liver resection (LR) is increasingly performed with CRS/HIPEC. METHODS: Patients from the US HIPEC Collaborative (2000-2017) with invasive appendiceal or colorectal adenocarcinoma undergoing primary, curative intent CRS/HIPEC with CC0-1 resection were included. LR was defined as a formal parenchymal resection. Primary endpoints were postoperative complications and overall survival (OS). RESULTS: A total of 658 patients were included. About 83 (15%) underwent LR of colorectal (58%) or invasive appendiceal (42%) metastases. LR patients had more complications (81% vs. 60%; p = .001), greater number of complications (2.3 vs. 1.5; p < .001) per patient and required more reoperations (22% vs. 11%; p = .007) and readmissions (39% vs. 25%; p = .014) than non-LR patients. LR patients had decreased OS (2-year OS 62% vs. 79%, p < .001), even when accounting for peritoneal carcinomatosis index and histology type. Preoperative factors associated with decreased OS on multivariable analysis in LR patients included age < 60 years (HR, 3.61; 95% CI, 1.10-11.81), colorectal histology (HR, 3.84; 95% CI, 1.69-12.65), and multiple liver tumors (HR, 3.45; 95% CI, 1.21-9.85) (all p < .05). When assigning one point for each factor, there was an incremental decrease in 2-year survival as the risk score increased from 0 to 3 (0: 100%; 1: 91%; 2: 58%; 3: 0%). CONCLUSIONS: As CRS/HIPEC + LR has become more common, we created a simple risk score to stratify patients considered for CRS/HIPEC + LR. These data aid in striking the balance between an increased perioperative complication profile with the potential for improvement in OS.
BACKGROUND: While parenchymal hepatic metastases were previously considered a contraindication to cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC), liver resection (LR) is increasingly performed with CRS/HIPEC. METHODS: Patients from the US HIPEC Collaborative (2000-2017) with invasive appendiceal or colorectal adenocarcinoma undergoing primary, curative intent CRS/HIPEC with CC0-1 resection were included. LR was defined as a formal parenchymal resection. Primary endpoints were postoperative complications and overall survival (OS). RESULTS: A total of 658 patients were included. About 83 (15%) underwent LR of colorectal (58%) or invasive appendiceal (42%) metastases. LR patients had more complications (81% vs. 60%; p = .001), greater number of complications (2.3 vs. 1.5; p < .001) per patient and required more reoperations (22% vs. 11%; p = .007) and readmissions (39% vs. 25%; p = .014) than non-LR patients. LR patients had decreased OS (2-year OS 62% vs. 79%, p < .001), even when accounting for peritoneal carcinomatosis index and histology type. Preoperative factors associated with decreased OS on multivariable analysis in LR patients included age < 60 years (HR, 3.61; 95% CI, 1.10-11.81), colorectal histology (HR, 3.84; 95% CI, 1.69-12.65), and multiple liver tumors (HR, 3.45; 95% CI, 1.21-9.85) (all p < .05). When assigning one point for each factor, there was an incremental decrease in 2-year survival as the risk score increased from 0 to 3 (0: 100%; 1: 91%; 2: 58%; 3: 0%). CONCLUSIONS: As CRS/HIPEC + LR has become more common, we created a simple risk score to stratify patients considered for CRS/HIPEC + LR. These data aid in striking the balance between an increased perioperative complication profile with the potential for improvement in OS.
Authors: A D Stephens; R Alderman; D Chang; G D Edwards; J Esquivel; G Sebbag; M A Steves; P H Sugarbaker Journal: Ann Surg Oncol Date: 1999-12 Impact factor: 5.344
Authors: Joel M Baumgartner; Laura Tobin; Sean F Heavey; Kaitlyn J Kelly; Eric J Roeland; Andrew M Lowy Journal: Ann Surg Oncol Date: 2014-08-22 Impact factor: 5.344
Authors: Stephanie Downs-Canner; Yongli Shuai; Lekshmi Ramalingam; James F Pingpank; Matthew P Holtzman; Herbert J Zeh; David L Bartlett; Haroon A Choudry Journal: J Surg Res Date: 2017-06-29 Impact factor: 2.192