PP107-MON SHORT TERM EVOLUTION OF NUTRITIONAL STATUS IN PATIENTS UNDERGOING CYTOREDUCTIVE SURGERY AND HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY

Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is an established treatment of peritoneal malignancies (PM). However, it can also adversely affect patients' quality of life (QoL). Aim: This study reports short-term QoL outcomes following CRS and HIPEC and compares the QoL trajectories between patients with more extensive cancer to those with less extensive disease. Methods: Patients undergoing CRS and HIPEC at a single referral center between April 2017 and April 2018 were prospectively recruited. QoL was measured using short-form 36 version 2. Physical (PCS) and mental component scores (MCS) were scored according to the manual (higher scores reflect better QoL). Data were collected at baseline, predischarge, 3 and 6 months postoperatively. PCS and MCS trajectories were described. Results: Of 68 patients, 62 (91%) entered the study. Median PCS decreased from baseline to predischarge but this then recovers and improves beyond baseline by 3 months (43.4 IQR 35.2-55.2, 34.3 IQR 27.3-43.5, 48.1 IQR 37.6-52.5). Median MCS declined marginally postoperatively but improves above baseline by 3 months and continues to improve at 6 months (49.6 IQR 43.5-55.7, 47.8 IQR 39.9-55.0, 51.2 IQR 43.7-57.3, 56.2 IQR 42.8-58.6). Using a PCI (peritoneal carcinoma index, a staging system for the extent of disease from 0-39, higher value denotes more extensive disease) ≥ 15, patients with high PCI were found to have worse PCS at baseline (36.5 vs 48.9, P < 0.005). Despite nonstatistically significant differences in MCS between high PCI and low PCI patients, there is a clinically significant trend among patients with high PCI in that the trajectory for MCS is one of continued decline. Conclusion: Short-term QoL after CRS and HIPEC is acceptable. QoL returned to baseline quicker than anticipated. Further studies are needed to describe the long-term QoL and in particular, the relationship between PCI and QoL needs further evaluation.

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Short-term morbidity and mortality associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent/advanced-stage ovarian cancer

Gynecologic Oncology ◽

10.1016/j.ygyno.2014.03.087 ◽

2014 ◽

Vol 133 ◽

pp. 27

Author(s):

J.C. Cripe ◽

J. Tseng ◽

R. Eskander ◽

S.D. Thompson ◽

A. Nickles Fader ◽

...

Keyword(s):

Ovarian Cancer ◽

Intraperitoneal Chemotherapy ◽

Cytoreductive Surgery ◽

Hyperthermic Intraperitoneal Chemotherapy ◽

Morbidity And Mortality ◽

Advanced Stage ◽

Short Term

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Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for perforated low-grade appendiceal mucinous neoplasms

Surgical Endoscopy ◽

10.1007/s00464-019-07349-x ◽

2020 ◽

Vol 34 (12) ◽

pp. 5516-5521 ◽

Cited By ~ 4

Author(s):

Haytham Abudeeb ◽

Chelliah R. Selvasekar ◽

Sarah T. O’Dwyer ◽

Bipasha Chakrabarty ◽

Lee Malcolmson ◽

...

Keyword(s):

Intraperitoneal Chemotherapy ◽

Cytoreductive Surgery ◽

Hyperthermic Intraperitoneal Chemotherapy ◽

Operative Time ◽

Significant Proportion ◽

Low Grade ◽

Short Term ◽

Open Operation ◽

High Dependency ◽

Mucinous Neoplasms

Abstract Introduction Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is an established treatment for pseudomyxoma peritonei (PMP) from perforated low-grade appendiceal mucinous neoplasms (LAMN II). In a selected group of LAMN II patients without established PMP, CRS/HIPEC can be performed laparoscopically (L-CRS/HIPEC); however the short-term benefits and safety of this approach have yet to be determined. This study aims to determine the short-term outcomes from a series of L-CRS/HIPEC LAMN II patients compared to those who have undergone a similar open operation (O-CRS/HIPEC) for low-volume PMP. Methods LAMN II patients undergoing L-CRS/HIPEC at a UK national peritoneal tumour centre were compared to O-CRS/HIPEC patients (peritoneal cancer index ≤ 7). Outcomes of interest included Clavien–Dindo complication grade, operative time, blood transfusions, high dependency unit (HDU) admission, length of hospital stay, and histopathological findings. Results 55 L-CRS/HIPEC were compared to 29 O-CRS/HIPEC patients (2003–2017). Groups were matched for age, sex, and procedures. Median operative time was 8.8 (IQR 8.1–9.5) h for L-CRS/HIPEC versus 7.3 (IQR 6.7–8) h for O-CRS/HIPEC (Mann–Whitney test p < 0.001). Post-operative HDU admission was 56% versus 97% (OR 0.04 95% CI 0.01–0.34) and median length of stay = 6 (IQR 5–8) versus 10 (IQR 8–11) days (p < 0.001) for L- versus O-CRS/HIPEC. Despite a normal pre-operative CT scan, 13/55 (23.6%) L-CRS/HIPEC patients had acellular mucin and 2/55 (3.5%) had mucin with epithelium present in their specimens. Residual appendix tumour was identified in 2/55 patients (3.6%). Clavien–Dindo Grade 1–4 complications were similar in both groups with no mortality. Conclusion L-CRS/HIPEC for LAMN II takes longer; however patients have significantly reduced length of HDU and overall stay, without increased post-operative complications. A significant proportion of LAMN II patients undergoing L-CRS/HIPEC have extra-appendiceal acellular mucin with some cases demonstrating residual cellular epithelium from the LAMN II. The risk of these patients developing PMP without surgery is under current review.

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Hyperthermic Intraperitoneal Chemotherapy After Cytoreductive Surgery; Experience and Short Term Outcomes

Alban Tanitim Ltd. STI ◽

10.47482/acmr.2021.32 ◽

2022 ◽

Vol 2 (3) ◽

pp. 168-176

Author(s):

Ahmet Karayiğit ◽

Hayrettin Dizen ◽

Ümit Özdemir ◽

Dursun Burak Özdemir ◽

İhsan Burak Karakaya ◽

...

Keyword(s):

Intraperitoneal Chemotherapy ◽

Cytoreductive Surgery ◽

Hyperthermic Intraperitoneal Chemotherapy ◽

Short Term

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Short-Term Postoperative Cognitive Dysfunction and Inflammatory Response in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Pilot Study

Mediators of Inflammation ◽

10.1155/2017/3605350 ◽

2017 ◽

Vol 2017 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Hui Yu ◽

Rui Dong ◽

Yayuan Lu ◽

Xi Yang ◽

Chang Chen ◽

...

Keyword(s):

Pilot Study ◽

Cognitive Dysfunction ◽

Intraperitoneal Chemotherapy ◽

Cytoreductive Surgery ◽

Hyperthermic Intraperitoneal Chemotherapy ◽

Inflammatory Marker ◽

Adult Patients ◽

Short Term ◽

Amyloid A ◽

S 100

Objectives. To assess the association between short-term postoperative cognitive dysfuction (POCD) and inflammtory response in patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Design. A prospective cohort study. Setting. University medical centre. Participants. Fifty-one adult patients who had undergone CRS-HIPEC and twenty control participants. Measurements. The inflammatory marker levels in plasma and cognitive function were measured. Results. Twenty (39.2%, 20/51) patients developed POCD at 1 w after CRS-HIPEC. The patients with POCD had higher serum interleukin 1β (IL-1β), serum amyloid A (SAA), S100 calcium-binding protein β (S-100β), and high mobility group box-1 protein (HMGB-1) levels at 1 and 24 h postoperatively than patients without POCD. There was an association between POCD and the maximum IL-1β and S-100β concentrations in serum, which remained following adjustment for age and FBS. Conclusion. In this pilot study, perioperative inflammatory marker levels increase significantly after CRS-HIPEC in adult patients, and such elevations are associated with the development of short-term cognitive dysfunction after this complex surgery. These results suggested the need for a larger RCT to replicate and confirm these findings.

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Prognostic Factors Influencing Infectious Complications after Cytoreductive Surgery and HIPEC: Results from a Tertiary Referral Center

Gastroenterology Research and Practice ◽

10.1155/2019/2824073 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Maurizio Cardi ◽

Simone Sibio ◽

Francesco Di Marzo ◽

Francesco Lefoche ◽

Claudia d’Agostino ◽

...

Keyword(s):

Prognostic Factors ◽

Nutritional Status ◽

Intraperitoneal Chemotherapy ◽

Cytoreductive Surgery ◽

Hyperthermic Intraperitoneal Chemotherapy ◽

Infectious Complications ◽

Peritoneal Metastases ◽

Complication Rates ◽

Crs And Hipec ◽

Clinical Records

Background. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) showed promising results in selected patients. High morbidity restrains its wide application. The aim of this study was to report postoperative infectious complications and investigate possible correlations with the preoperative nutritional status and other prognostic factors in patients with peritoneal metastases treated with CRS and HIPEC. Methods. For the study, we reviewed the clinical records of all patients with peritoneal metastases from different primary cancers treated with CRS and HIPEC in our Institution from November 2000 to December 2017. Patients were divided according to their nutritional status (SGA) into groups A (well-nourished) and B/C (mild or severely malnourished, respectively). Possible statistical correlations between risk factors and postoperative complication rates have been investigated by univariate and multivariate analysis. Results. Two hundred patients were selected and underwent CRS and HIPEC during the study period. Postoperative complications occurred in 44% of the patients, 35.3% in SGA-A patients, and 53% in SGA-B/C patients. Cause of complications was infective in 42, noninfective in 37, and HIPEC related in 9 patients. Infectious complications occurred more frequently in SGA-B/C patients (32.6% vs. 9.8% of SGA-A patients). The most frequent sites of infection were surgical site infections (SSI, 35.7%) and central line-associated bloodstream infections (CLABSI, 26.2%). The most frequent isolated species was Candida (22.8%). ASA score, blood loss, performance status, PCI, large bowel resection, postoperative serum albumin levels, and nutritional status correlated with higher risk for postoperative infectious complications. Conclusions. Malnourished patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy are more prone to postoperative infectious complications, and adequate perioperative nutritional support should be considered, including immune-enhancing nutrition. Sequential monitoring of common sites of infection, antifungal prevention of candidiasis, and careful patient selection should be implemented to reduce the complication rate.

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