Early Postoperative Extubation is Associated with Shorter Hospitalization and Improved Short-Term Survival in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

2022 ◽  
pp. 000313482110505
Author(s):  
Leah E. Hendrick ◽  
Xin Huang ◽  
William P. Hewgley ◽  
Luke Douthitt ◽  
Paxton V. Dickson ◽  
...  
Keyword(s):  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Survival Benefit ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Regression Coefficient ◽  
Hospital Length Of Stay ◽  
Term Survival ◽  
Factors Associated ◽  
Kaplan Meier ◽  
Early Survival

Background Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is associated with significant operative time, hospital resources, and morbidity. We examine factors associated with hospital length of stay (LOS) and early overall survival (OS) after CRS/HIPEC. Materials and Methods Patients who underwent CRS/HIPEC were evaluated for factors associated with LOS. Institutional learning curve influence was addressed by comparing early vs late cohorts. Variables with P < .200 after univariate analysis were considered for inclusion in multivariate linear regression modeling. Independent factors associated with OS were evaluated using the Kaplan-Meier method. Results Seventy patients underwent CRS/HIPEC (mean age 52.3 years, 64.3% female, and 68.6% Caucasian). Presence of any surgical complication was found in 26 (37.1%), 28 (40%) remained intubated postoperatively, and the mean Peritoneal Carcinomatosis Index (PCI) score was 14.4 ([Formula: see text]10.4). Mean intensive care unit and hospital LOS were 2.9 days ([Formula: see text]2.3) and 9.6 days ([Formula: see text]3.6), respectively. After adjusting for covariates, only shorter time to postoperative ambulation (regression coefficient .92, P = .001) and early extubation (regression coefficient −1.90, P = .018) were associated with decreased hospital LOS on multivariate analysis. Immediate postoperative extubation conferred an independent early survival benefit on Kaplan-Meier analysis (mean OS 714.8 vs 473.4 days, P = .010). There was no difference in hospital LOS or OS between early and late cohorts. Conclusion Early postoperative extubation and shorter time to ambulation are associated with decreased hospital LOS. Moreover, CRS/HIPEC patients extubated immediately postoperatively have an early survival benefit. Every effort should be made to achieve early postoperative extubation and mobilization in CRS/HIPEC patients.

scholarly journals Outcomes of multicystic peritoneal mesothelioma treatment with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

BJS Open ◽  
2020 ◽  
Vol 5 (2) ◽  
Author(s):  
A Zahid ◽  
L Clarke ◽  
N Carr ◽  
K Chandrakumaran ◽  
A Tzivanakis ◽  
...  
Keyword(s):  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Peritoneal Mesothelioma ◽  
Residual Tumour ◽  
Term Survival ◽  
Kaplan Meier ◽  
Peritoneal Neoplasm ◽  
Crs And Hipec

Abstract Background Multicystic peritoneal mesothelioma (MCPM) is a rare neoplasm, generally considered a borderline malignancy, best treated by cytoreductive surgery (CRS) to remove macroscopic disease, combined with hyperthermic intraperitoneal chemotherapy (HIPEC). Owing to its rarity, little has been published on clinical presentation, clinical behaviour over time, or an optimal treatment approach. Methods A prospectively developed peritoneal malignancy database was interrogated for the years 2001–2018. Details on all patients with MCPM as a definitive diagnosis after CRS and HIPEC were analysed, including previous interventions, mode of presentation, surgical treatment, postoperative outcomes, and late follow-up information from abdominal CT and tumour markers. Results Some 40 patients with MCPM underwent CRS and HIPEC between 2001 and 2018. Of these, 32 presented with abdominal pain, distension or bloating, six patients presented with recurrence following previous surgery at the referring hospitals, and two had coincidental diagnoses during a surgical procedure. CRS involved peritonectomy in all 40 patients. Bowel resection was required in 18 patients, and seven had a temporary stoma. Thirty-eight patients were considered to have undergone a complete macroscopic tumour removal (completeness of cytoreduction CC0), and two had residual tumour nodules less than 2.5 mm in size, classified as CC1. Median duration of follow-up was 65 (range 48–79) months. There were no deaths during follow-up. The Kaplan–Meier-predicted recurrence-free interval was 115.4 months. Conclusion MCPM is a rare peritoneal neoplasm with a heterogeneous pattern of presentation. CRS and HIPEC is an effective management option for this group of patients, with favourable long-term survival.

scholarly journals Survival outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from gastric cancer: a systematic review

2016 ◽  
Vol 1 (2) ◽  
pp. 67-77 ◽  
Author(s):  
Claramae Shulyn Chia ◽  
Ramakrishnan Ayloor Seshadri ◽  
Vahan Kepenekian ◽  
Delphine Vaudoyer ◽  
Guillaume Passot ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Peritoneal Carcinomatosis ◽  
Median Survival ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Current Evidence ◽  
Term Survival ◽  
Crs And Hipec

AbstractBackground: The current treatment of choice for peritoneal carcinomatosis from gastric cancer is systemic chemotherapy. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a new aggressive form of loco-regional treatment that is currently being used in pseudomyxoma peritoneii, peritoneal mesothelioma and peritoneal carcinomatosis from colorectal cancer. It is still under investigation for its use in gastric cancer.Methods: The literature between 1970 and 2016 was surveyed systematically through a review of published studies on the treatment outcomes of CRS and HIPEC for peritoneal carcinomatosis from gastric cancer.Results: Seventeen studies were included in this review. The median survival for all patients ranged from 6.6 to 15.8 months. The 5-years overall survival ranged from 6 to 31%. For patients with complete cytoreduction, the median survival was 11.2 to 43.4 months and the 5-years overall survival was 13 % to 23%. Important prognostic factors were found to be a low peritoneal carcarcinomatosis index (PCI) score and the completeness of cytoreduction.Conclusion: The current evidence suggests that CRS and HIPEC has a role to play in the treatment of peritoneal carcinomatosis from gastric cancer. Long term survival has been shown for a select group of patients. However, further studies are needed to validate these results.

Factors Associated with Readmission After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis

2016 ◽  
Vol 23 (6) ◽  
pp. 1941-1947 ◽  
Author(s):  
Alexander S. Martin ◽  
Daniel E. Abbott ◽  
Dennis Hanseman ◽  
Jonathan E. Sussman ◽  
Alexander Kenkel ◽  
...  
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Factors Associated

scholarly journals Is Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Indicated in Hepatobiliary Malignancies?

2020 ◽  
Author(s):  
Natasha Leigh ◽  
Daniel Solomon ◽  
Eric Pletcher ◽  
Daniel M. Labow ◽  
Deepa R. Magge ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Survival Benefit ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Systemic Chemotherapy ◽  
Oncologic Outcomes ◽  
Poor Survival ◽  
Current Therapies

Abstract Background Hepatopancreaticobiliary malignancies with peritoneal carcinomatosis (PC) exhibit poor survival with current therapies; HCC 11 months with sorafenib, pancreaticobiliary 9-14 months with systemic chemotherapy. Methods We retrospectively reviewed our institutional hepatopancreaticobiliary malignancies with PC which underwent CRS/HIPEC from 2007-2017 and analyzed perioperative and oncologic outcomes. Results 17 patients were included; 9 HCC, 8 pancreaticobiliary (4 cholangiocarcinoma, 3 gallbladder, 1 pancreatic). PCI (12 vs. 9), completeness of cytoreduction (78% vs. 75%) and 30-day morbidity (11% vs. 13%) were equivalent. HCC received less neoadjuvant therapy (11% vs. 75%, p=0.008), though adjuvant therapy rates were similar (78% vs. 100%, p=0.156). At a median follow-up of 15 months, PFS was similar (7 vs. 10 months p=0.957). However, OS was longer in HCC (42 vs. 15 months p=0.206) with 59% 3-year OS (vs. 0% pancreaticobiliary). Conclusions CRS/HIPEC may offer a survival benefit in select HCC patients with PC, though has dubious utility in PB malignancies.

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