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

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

Clinical Nutrition ◽

10.1016/s0261-5614(13)60418-5 ◽

2013 ◽

Vol 32 ◽

pp. S162

Author(s):

M. Camblor ◽

M.L. Carrascal ◽

C. Velasco ◽

I. Higuera ◽

C. Cuerda ◽

...

Keyword(s):

Nutritional Status ◽

Intraperitoneal Chemotherapy ◽

Cytoreductive Surgery ◽

Hyperthermic Intraperitoneal Chemotherapy ◽

Short Term ◽

Term Evolution

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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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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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