Nasogastric- vs. percutaneous gastrostomy tube for prophylactic gastric decompression after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

Abstract Objectives Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with postoperative gastroparesis and ileus. In 2015, our practice shifted from using percutaneous gastrostomy tubes (PGT), to nasogastric tubes (NGT) for prophylactic gastric decompression after CRS-HIPEC. This study aimed to compare these methods for length of stay (LOS) and associated complications. Methods Patients that underwent CRS-HIPEC for peritoneal metastases from colorectal cancer between 2014 and 2019 were included. Cases were grouped based on receiving NGT or PGT postoperatively. Multivariable linear regression determined the independent effect of decompression method on LOS, thereby adjusting for confounders. Results In total, 179 patients were included in the analyses. Median age was 64 years [IQR:54–71]. Altogether, 135 (75.4%) received a NGT and 44 (24.6%) received a PGT. Gastroparesis occurred significantly more often in the PGT group (18.2 vs. 7.4%, p=0.039). Median LOS was significantly shorter for patients with a NGT (15 [IQR:12–19] vs. 18.5 [IQR:17–25.5], p<0.001). PGT was independently associated with longer LOS in multivariable analysis (Beta=4.224 [95%CI 1.243–7.204]). There was no difference regarding aspiration, pneumonia and postoperative mortality between groups. Conclusions NGT should be preferred over PGT for gastric decompression after CRS-HIPEC as it is associated with fewer gastroparesis and shorter LOS.

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Impact of Neoadjuvant Chemotherapy on the Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases: A Multi-Institutional Retrospective Review

Journal of Clinical Medicine ◽

10.3390/jcm9030748 ◽

2020 ◽

Vol 9 (3) ◽

pp. 748 ◽

Cited By ~ 2

Author(s):

Eliza W. Beal ◽

Lorena P. Suarez-Kelly ◽

Charles W. Kimbrough ◽

Fabian M. Johnston ◽

Jonathan Greer ◽

...

Keyword(s):

Neoadjuvant Chemotherapy ◽

Intraperitoneal Chemotherapy ◽

Cytoreductive Surgery ◽

Retrospective Review ◽

Hyperthermic Intraperitoneal Chemotherapy ◽

Peritoneal Cancer Index ◽

Multivariable Analysis ◽

Peritoneal Metastases ◽

Peritoneal Cancer ◽

Significant Difference

Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with improved survival for patients with colorectal peritoneal metastases (CR-PM). However, the role of neoadjuvant chemotherapy (NAC) prior to CRS-HIPEC is poorly understood. A retrospective review of adult patients with CR-PM who underwent CRS+/-HIPEC from 2000–2017 was performed. Among 298 patients who underwent CRS+/-HIPEC, 196 (65.8%) received NAC while 102 (34.2%) underwent surgery first (SF). Patients who received NAC had lower peritoneal cancer index score (12.1 + 7.9 vs. 14.3 + 8.5, p = 0.034). There was no significant difference in grade III/IV complications (22.4% vs. 16.7%, p = 0.650), readmission (32.3% vs. 23.5%, p = 0.114), or 30-day mortality (1.5% vs. 2.9%, p = 0.411) between groups. NAC patients experienced longer overall survival (OS) (median 32.7 vs. 22.0 months, p = 0.044) but similar recurrence-free survival (RFS) (median 13.8 vs. 13.0 months, p = 0.456). After controlling for confounding factors, NAC was not independently associated with improved OS (OR 0.80) or RFS (OR 1.04). Among patients who underwent CRS+/-HIPEC for CR-PM, the use of NAC was associated with improved OS that did not persist on multivariable analysis. However, NAC prior to CRS+/-HIPEC was a safe and feasible strategy for CR-PM, which may aid in the appropriate selection of patients for aggressive cytoreductive surgery.

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Frailty Correlates with Postoperative Mortality and Major Morbidity After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy

Annals of Surgical Oncology ◽

10.1245/s10434-017-6111-0 ◽

2017 ◽

Vol 24 (13) ◽

pp. 3825-3830 ◽

Cited By ~ 10

Author(s):

Ioannis T. Konstantinidis ◽

Konstantinos Chouliaras ◽

Edward A. Levine ◽

Byrne Lee ◽

Konstantinos I. Votanopoulos

Keyword(s):

Intraperitoneal Chemotherapy ◽

Cytoreductive Surgery ◽

Hyperthermic Intraperitoneal Chemotherapy ◽

Postoperative Mortality ◽

Major Morbidity

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Comparison of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy with Mitomycin or Carboplatin for Diffuse Malignant Peritoneal Mesothelioma

The American Surgeon ◽

10.1177/000313481408000415 ◽

2014 ◽

Vol 80 (4) ◽

pp. 348-352 ◽

Cited By ~ 5

Author(s):

Shreya J. Shetty ◽

Lokesh Bathla ◽

Venkatesh Govindarajan ◽

Peter Thomas ◽

Brian W. Loggie

Keyword(s):

Overall Survival ◽

Median Survival ◽

Intraperitoneal Chemotherapy ◽

Cytoreductive Surgery ◽

Hyperthermic Intraperitoneal Chemotherapy ◽

Postoperative Mortality ◽

Peritoneal Mesothelioma ◽

Rank Test ◽

Malignant Peritoneal Mesothelioma ◽

Diffuse Malignant Peritoneal Mesothelioma

Diffuse malignant peritoneal mesothelioma is a rare, aggressive disease. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have improved outcomes where systemic chemotherapy has not succeeded. In this study, we compare outcomes of patients treated with mitomycin or carboplatin as perfusate. In this retrospective study, 47 procedures (CRS + HIPEC) were conducted on 44 patients between March 2003 and August 2010 with either mitomycin or carboplatin. χ2 and Student's t test were used for comparison of clinicopathological variables and Kaplan-Meier curves and log rank test were used to compare overall survival. Median survival of the mitomycin group was 18 months with 1- and 5-year survivals of 72.3 and 27.3 per cent, respectively. Median survival of the carboplatin group was not reached and 1- and 5-year survivals were 89.7 and 62.5 per cent, respectively ( P = 0.014). Mean hospital and intensive care unit length of stay was 18.9 and 8.7 days in the mitomycin group and 12.5 and 2.3 days in the carboplatin group ( P = 0.0069). Mean number of packed red blood cell units transfused was higher in the mitomycin group compared with the carboplatin group (3.54 vs 0.83, P < 0.05). There was no postoperative mortality. HIPEC with carboplatin in diffuse malignant peritoneal mesothelioma is associated with improved overall survival and shorter hospital stay compared with HIPEC with mitomycin.

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OUTCOMES OF CYTOREDUCTIVE SURGERY AND HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY (CRS/HIPEC) IN THE TREATMENT OF PRIMARY PERITONEAL CARCINOMA

10.26226/morressier.5770e29dd462b80290b4bece ◽

2016 ◽

Author(s):

Victoria Eskay

Keyword(s):

Intraperitoneal Chemotherapy ◽

Cytoreductive Surgery ◽

Hyperthermic Intraperitoneal Chemotherapy ◽

Peritoneal Carcinoma ◽

Primary Peritoneal Carcinoma

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Connection between serum lactate levels and postoperative outcomes in patients undergoing cytoreductive surgery associated with hyperthermic intraperitoneal chemotherapy

10.26226/morressier.57108e31d462b80290b4aaa9 ◽

2016 ◽

Author(s):

Dayana Florez

Keyword(s):

Intraperitoneal Chemotherapy ◽

Cytoreductive Surgery ◽

Hyperthermic Intraperitoneal Chemotherapy ◽

Serum Lactate ◽

Postoperative Outcomes ◽

Lactate Levels

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Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Peritoneal Carcinomatosis From Ovarian Cancer (Cyto-chip 2)

Case Medical Research ◽

10.31525/ct1-nct03931304 ◽

2019 ◽

Author(s):

Keyword(s):

Ovarian Cancer ◽

Peritoneal Carcinomatosis ◽

Intraperitoneal Chemotherapy ◽

Cytoreductive Surgery ◽

Hyperthermic Intraperitoneal Chemotherapy

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Physiologic and hemodynamic changes in patients undergoing open abdominal cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

Journal of International Medical Research ◽

10.1177/0300060520983263 ◽

2021 ◽

Vol 49 (1) ◽

pp. 030006052098326

Author(s):

Myoung Hwa Kim ◽

Young Chul Yoo ◽

Sun Joon Bai ◽

Kang-Young Lee ◽

Nayeon Kim ◽

...

Keyword(s):

Body Temperature ◽

Systemic Vascular Resistance ◽

Vascular Resistance ◽

Intraperitoneal Chemotherapy ◽

Cytoreductive Surgery ◽

Hyperthermic Intraperitoneal Chemotherapy ◽

Resistance Index ◽

Volume Index ◽

Hemodynamic Changes ◽

Arterial Blood

Objective We aimed to determine the physiological and hemodynamic changes in patients who were undergoing hyperthermic intraperitoneal chemotherapy (HIPEC) cytoreductive surgeries. Methods This prospective, observational study enrolled 21 patients who were undergoing elective cytoreductive surgery with HIPEC at our hospital over 2 years. We collected vital signs, hemodynamic parameters including global end-diastolic volume index (GEVI) and extravascular lung water index (ELWI) using the VolumeView™ system, and arterial blood gas analysis from all patients. Data were recorded before skin incision (T1); 30 minutes before HIPEC initiation (T2); 30 (T3), 60 (T4), and 90 (T5) minutes after HIPEC initiation; 30 minutes after HIPEC completion (T6); and 10 minutes before surgery completion (T7). Results Patients showed an increase in body temperature and cardiac index and a decrease in the systemic vascular resistance index. GEDI was 715.4 (T1) to 809.7 (T6), and ELWI was 6.9 (T1) to 7.3 (T5). Conclusions HIPEC increased patients’ body temperature and cardiac output and decreased systemic vascular resistance. Although parameters that were extracted from the VolumeView™ system were within their normal ranges, transpulmonary thermodilution approach is helpful in intraoperative hemodynamic management during open abdominal cytoreductive surgery with HIPEC. Trial registry name: ClinicalTrials.gov Trial registration number: NCT02325648 URL: https://clinicaltrials.gov/ct2/results?cond=NCT02325648&term

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Sclerosing Encapsulating Peritonitis after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Description of 4 Cases

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2020.11.184 ◽

2021 ◽

Vol 47 (2) ◽

pp. e14-e15 ◽

Cited By ~ 1

Author(s):

Fernando Arias-Amézquita ◽

Eduardo Londoño-Schimmer ◽

Jorge Miguel Otero-Bernal ◽

Camilo Cétares ◽

Martha Mora ◽

...

Keyword(s):

Intraperitoneal Chemotherapy ◽

Cytoreductive Surgery ◽

Hyperthermic Intraperitoneal Chemotherapy ◽

Sclerosing Encapsulating Peritonitis ◽

Encapsulating Peritonitis

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Cytoreductive Surgery Combined with Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Metastasis from Colorectal Cancer

Clinics in Colon and Rectal Surgery ◽

10.1055/s-0040-1714242 ◽

2020 ◽

Vol 33 (06) ◽

pp. 372-376

Author(s):

Hideaki Yano

Keyword(s):

Colorectal Cancer ◽

Intraperitoneal Chemotherapy ◽

Cytoreductive Surgery ◽

Peritoneal Metastasis ◽

Hyperthermic Intraperitoneal Chemotherapy ◽

Peritoneal Cancer Index ◽

Systemic Disease ◽

Good Reason ◽

Standard Of Care ◽

Peritoneal Cancer

AbstractPeritoneal metastasis from colorectal cancer (PM-CRC) is used to be considered a systemic and fatal condition; however, it has been growingly accepted that PM-CRC can still be local disease rather than systemic disease as analogous to liver or lung metastasis.Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is now considered an optimal treatment for PM-CRC with accumulating evidence. There is a good reason that CRS + HIPEC, widely accepted as a standard of care for pseudomyxoma peritonei (PMP), could be a viable option for PM-CRC given a similarity between PM-CRC and PMP.Recent years have also seen that modern systemic chemotherapy with or without molecular targeted agents can be effective for PM-CRC. It is possible that neoadjuvant or adjuvant chemotherapy combined with CRS + HIPEC could further improve outcomes.Patient selection, utilizing modern images and increasingly laparoscopy, is crucial. Particularly, diagnostic laparoscopy is likely to play a significant role in predicting the likelihood of achieving complete cytoreduction and assessing the peritoneal cancer index score.

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