HIPEC + EPIC versus HIPEC-alone: differences in major complications following cytoreduction surgery for peritoneal malignancy.

Autor: McConnell YJ; Department of Surgery and Oncology, University of Calgary, Calgary, Alberta, Canada. yarrow.mcconnell@albertahealthsciences.ca, Mack LA, Francis WP, Ho T, Temple WJ
Jazyk: angličtina
Zdroj: Journal of surgical oncology [J Surg Oncol] 2013 May; Vol. 107 (6), pp. 591-6. Date of Electronic Publication: 2012 Nov 05.
DOI: 10.1002/jso.23276
Abstrakt: Introduction: Peritoneal metastases (PM) can be treated with cytoreduction surgery (CRS) with intraoperative heated intraperitoneal chemotherapy (HIPEC) plus or minus early postoperative intraperitoneal chemotherapy (EPIC). HIPEC + EPIC may be associated with more complications than HIPEC alone.
Methods: A prospective database of consecutive patients undergoing CRS + HIPEC ± EPIC at the University of Calgary between February 2000 and May 2011 was reviewed. Patient, tumor, and perioperative variables included peritoneal cancer index (PCI), completeness of cytoreduction (CCR) score, HIPEC ± EPIC type, and grade III/IV complications.
Results: 198 patients had a CCR score of 0/1 and received: (1) HIPEC mitomycin C + EPIC 5-fluorouracil for 5 days (n = 85; February 2000-January 2008); or (2) HIPEC oxaliplatin with IV 5-fluorouracil + no EPIC (n = 113; February 2008-May 2011). Clinicodemographics were similar except PCI was higher in the HIPEC-alone group (mean PCI 22 vs. 17; P = 0.02). The rate of grade III/IV complications was higher in the HIPEC + EPIC group (44.7% vs. 31.0%; P = 0.05). On multivariate logistic regression only HIPEC + EPIC and PCI > 26 were associated with an increased rate of complications.
Conclusion: In patients with PM, the use of EPIC, in combination with CRS and HIPEC, is associated with an increased rate of complications. Surgeons should consider using HIPEC only (without EPIC).
(Copyright © 2012 Wiley Periodicals, Inc.)
Databáze: MEDLINE
Externí odkaz: