Selection Criteria for Complete Cytoreduction after Cytoreductive Surgery for Peritoneal Surface Malignancy: Lessons Learned from Our First Series of Patients

2011 ◽  
Vol 77 (4) ◽  
pp. 430-437
Author(s):  
Shaun Mckenzie ◽  
Avo Artinyan ◽  
Alicia D. Holt ◽  
Julio Garcia-Aguilar ◽  
Joshua Ellenhorn ◽  
...  
Keyword(s):  
Small Bowel ◽  
Cytoreductive Surgery ◽  
Selection Criteria ◽  
Peritoneal Cancer Index ◽  
Univariate Analysis ◽  
Lessons Learned ◽  
Complete Cytoreduction ◽  
Peritoneal Surface Malignancy ◽  
Peritoneal Surface ◽  
Incomplete Cytoreduction

The appropriate selection criteria for complete cytoreduction in patients with peritoneal surface malignancies have not been determined. We performed a retrospective analysis of all patients receiving cytoreductive surgery (CRS) during the study period of 2004 to 2008 to determine appropriate selection criteria for successful complete cytoreduction. During the study period, 38 patients underwent attempted CRS. Cytoreduction was scored complete, incomplete, or not reported in 53 per cent (n = 20), 37 per cent (n = 14), and 11 per cent (n = 4), respectively. Median overall survival for compete and incomplete cytoreduction was 56 months versus 5 months ( P = 0.011), respectively. Compared with incomplete cytoreduction, patients receiving complete cytoreduction were more likely to have a lower Peritoneal Cancer Index (PCI) and not have received preoperative systemic chemotherapy (CT). Univariate analysis verified PCI greater than 20 (hazard ratio [HR], 0.048; CI, 0.004 to 0.515; P = 0.01) and CT (HR, 0.17; 0.004 to 0.77; P = 0.021) as predictors of incomplete cytoreduction. Small bowel (100%), periportal region (33%), and mesentery (27%) were the most common sites of residual disease. In conclusion, PCI less than 20 and the need for preoperative chemotherapy should be strongly considered when selecting patients with peritoneal surface malignancy for attempted cytoreduction. Early evaluation of the small bowel, mesentery, and periportal region for resectability prevents unnecessary surgery.

scholarly journals Prognostic Relevance of the Peritoneal Surface Disease Severity Score Compared to the Peritoneal Cancer Index for Colorectal Peritoneal Carcinomatosis

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Jia Lin Ng ◽  
Whee Sze Ong ◽  
Claramae Shulyn Chia ◽  
Grace Hwei Ching Tan ◽  
Khee-Chee Soo ◽  
...  
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Disease Severity ◽  
Severity Score ◽  
Peritoneal Cancer Index ◽  
Prognostic Score ◽  
Univariate Analysis ◽  
Complete Cytoreduction ◽  
Disease Severity Score ◽  
Peritoneal Cancer ◽  
Peritoneal Surface

Background. Peritoneal Carcinomatosis Index (PCI) is a widely established scoring system that describes disease burden in isolated colorectal peritoneal carcinomatosis (CPC). Its significance may be diminished with complete cytoreduction. We explore the utility of the recently described Peritoneal Surface Disease Severity Score (PSDSS) and compare its prognostic value against PCI.Methods.The endpoints were overall survival (OS), progression-free survival (PFS), and survival less than 18 months (18 MS).Results.Fifty patients underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for CPC from 2003 to 2014, with 98% achieving complete cytoreduction. Median OS was 28.8 months (95% CI, 18.0–39.1); median PFS was 9.4 months (95% CI, 7.7–13.9). Univariate analysis showed that higher PCI was significantly associated with poorer OS (HR 1.11; 95% CI, 1.03–1.20) and PFS (HR 1.09; 95% CI, 1.03–1.14). Conversely, PSDSS was not associated with either endpoint. Multivariate analysis showed that PCI, but not PSDSS, was predictive of OS and PFS. PCI was also able to discriminate survival outcomes better than PSDSS for both OS and PFS. There was no association between 18 MS and either score.Conclusion.PCI is superior to PSDSS in predicting OS and PFS and remains the prognostic score of choice in CPC patients undergoing CRS/HIPEC.

scholarly journals Gastrointestinal Complications in 147 Consecutive Patients with Peritoneal Surface Malignancy Treated by Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy

2011 ◽  
Vol 2011 ◽  
pp. 1-10 ◽  
Author(s):  
Angela Casado-Adam ◽  
Robert Alderman ◽  
O. Anthony Stuart ◽  
David Chang ◽  
Paul H. Sugarbaker
Keyword(s):  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Peritoneal Cancer Index ◽  
Univariate Analysis ◽  
Colorectal Anastomosis ◽  
Morbidity Rate ◽  
Peritoneal Surface Malignancy ◽  
Gastrointestinal Malignancies ◽  
Gastrointestinal Complications ◽  
Gastrointestinal Events

Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is increasingly used in the treatment of peritoneal carcinomatosis from gastrointestinal malignancies. The purpose of this study is to reevaluate the incidence of gastrointestinal events and identify risk factors associated with this treatment approach. Between January 1, 2006 and December 31, 2009, 147 patients with appendiceal and colorectal carcinomatosis were treated. Gastrointestinal events were analyzed. The overall incidence of grade I–IV gastrointestinal events was 17%. There were 4 grade III gastrointestinal events that occurred in 4 patients and 11 grade IV gastrointestinal events that occurred in 8 patients. On univariate analysis of grade I–IV events a statistically significant association was observed with the following variables: histological grade, peritoneal cancer index (PCI), small bowel resection, colorectal anastomosis, and the number of anastomoses performed per patient. By multivariate analysis, PCI was identified as the only independent risk factor for gastrointestinal complications. CRS combined with a uniform HIPEC regimen is associated with a 17% gastrointestinal morbidity rate (grade I–IV). The frequency of gastrointestinal complications was associated with a large extent of disease measured by PCI (>30).

scholarly journals Treatment-related post-operative mortality after cytoreductive surgery and perioperative intraperitoneal chemotherapy

2017 ◽  
Author(s):  
Boyoung Kim ◽  
Nayef Alzahrani ◽  
Sarah J. Valle ◽  
Winston Liauw ◽  
David L. Morris
Keyword(s):  
Hospital Mortality ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Operative Mortality ◽  
Peritoneal Cancer Index ◽  
Univariate Analysis ◽  
Postoperative Mortality ◽  
Peritoneal Surface Malignancy ◽  
Peritoneal Cancer ◽  
Increased Risk

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has an established role in selected patients for the treatment of peritoneal surface malignancy. However, CRS/HIPEC is associated with increased risk of morbidity and mortality. The aim of this review was to identify risk factors for post-operative mortality in an attempt to improve patient outcomes post CRS/HIPEC. This is a retrospective study of prospectively collected data on 1019 patients who underwent CRS/HIPEC by the same surgical team at St George Hospital, Kogarah, Australia, between January 1996 and July 2016. During the 20-year time-period seventeen patients (1.67%) died postoperatively. A higher peritoneal cancer index (PCI), completeness of cytoreduction (CC) score, longer operative time and a volume of intra-operative transfusion were evident in the hospital mortality group and were significantly associated with postoperative mortality on univariate analysis. Postoperative complications including infection, bleeding, pneumonia, fistula, collection and pancreatic leak were also associated with post-operative mortality. The most common cause of death was sepsis (n=15, 88.2%). It is difficult to determine pre-operative factors that can be utilized as predictors of post-operative mortality, as the overall incidence of in-hospital mortality post CRS/HIPEC was very low on our unit. Nevertheless, a cascade of events and learning curve was displayed.

scholarly journals Prognostic Factors of Peritoneal Metastases from Colorectal Cancer following Cytoreductive Surgery and Perioperative Chemotherapy

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Yutaka Yonemura ◽  
Emel Canbay ◽  
Haruaki Ishibashi
Keyword(s):  
Colorectal Cancer ◽  
Prognostic Factors ◽  
Cytoreductive Surgery ◽  
Peritoneal Cancer Index ◽  
Complete Cytoreduction ◽  
Perioperative Chemotherapy ◽  
Peritoneal Cancer ◽  
Colorectal Origin ◽  
Grade 3 ◽  
Cox Hazard Model

Background. Prolonged survival of patients affected by peritoneal metastasis (PM) of colorectal origin treated with complete cytoreduction followed by intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) has been reported. However, two-thirds of the patients after complete cytoreduction and perioperative chemotherapy (POC) develop recurrence. This study is to analyze the prognostic factors of PM from colorectal cancer following the treatment with cytoreductive surgery (CRS) + POC.Patients and Methods. During the last 8 years, 142 patients with PM of colorectal origin have been treated with CRS and perioperative chemotherapy. The surgical resections consisted of a combination of peritonectomy procedures.Results. Complete cytoreduction (CCR-0) was achieved at a higher rate in patients with peritoneal cancer index (PCI) score less than 10 (94.7%, 71/75) than those of PCI score above 11 (40.2%, 37/67). Regarding the PCI of small bowel (SB-PCI), 89 of 94 (91.5%) patients with ≤2 and 22 of 48 (45.8%) patients with SB-PCI ≥ 3 received CCR-0 resection (P<0.001). Postoperative Grade 3 and Grade 4 complications occurred in 11 (7.7%) and 14 (9.9%). The overall operative mortality rate was 0.7% (1/142). Cox hazard model showed that CCR-0, SB-PCI ≤ 2, differentiated carcinoma, and PCI ≤ 10 were the independent favorite prognostic factors.Conclusions. Complete cytoreduction, PCI, SB-PCI threshold, and histologic type were the independent prognostic factors.

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