Genitourinary resection at the time of cytoreductive surgery and heated intraperitoneal chemotherapy for peritoneal carcinomatosis is not associated with increased morbidity or worsened oncologic outcomes: a case-matched study
| Autor: | Umut Sarpel, Daniel M. Labow, Michael S. Leapman, Spiros P. Hiotis, Simon J. Hall, Bernardo Franssen, Michael Palese, Parissa Tabrizian, Anya Romanoff, Ming-Jim Yang, Ghalib Jibara |
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| Rok vydání: | 2013 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Comorbidity Surgical oncology Gastrectomy Antineoplastic Combined Chemotherapy Protocols otorhinolaryngologic diseases Medicine Humans Prospective Studies Peritoneal Neoplasms Aged Neoplasm Staging Retrospective Studies Pelvic exenteration business.industry Genitourinary system Mortality rate Intraperitoneal chemotherapy Hyperthermia Induced Middle Aged Prognosis Combined Modality Therapy Peritoneal carcinomatosis Surgery Survival Rate Oncology Case-Control Studies Chemotherapy Cancer Regional Perfusion Peritoneal Cancer Index Female Neoplasm Recurrence Local business Cytoreductive surgery Urogenital Neoplasms Follow-Up Studies |
| Zdroj: | Annals of surgical oncology. 21(4) |
| ISSN: | 1534-4681 |
| Popis: | Cytoreductive surgery (CRS) with heated intraperitoneal chemotherapy (HIPEC) has gained acceptance in the treatment of peritoneal carcinomatosis with reported morbidity and mortality rates of 27-56 and 0-11 %, respectively. The safety and oncologic outcome of genitourinary repair at the time of CRS and HIPEC remains unclear.We identified 170 patients who underwent CRS-HIPEC at our institution between July 2007 and August 2011 with a minimum follow-up of 6 months. Thirty-four (20 %) underwent concomitant urologic reconstruction at the time of CRS-HIPEC and were matched by disease burden (intraoperative peritoneal cancer index [PCI]) and extent of surgery (ΔPCI) with a cohort of 38 (22.3 %) subjects without genitourinary involvement. The primary end points considered for this analysis included the development of major surgical (Clavien-Dindo Class III-V) complications and overall survival.Median follow-up was 9.4 months. The most commonly performed urologic interventions included partial cystectomy with primary repair in 23 (65.7 %) and segmental ureteral resection and repair in 11 (31.4 %). Patients with genitourinary reconstruction had more total organ involvement (6.5 vs. 4.3, p0.001) and more commonly underwent enteric anastomoses (82.4 vs. 57.9 %, p = 0.025). No significant differences were observed with regard to major morbidity, need for transfusion, operative time, intensive care unit admission, or length of stay. Among patients with appendiceal or colonic tumors (n = 46), overall survival was similar between genitourinary reconstruction and matched cohorts: 22.5 versus 15.1 months, respectively (p = 0.66).Genitourinary reconstruction at the time of CRS-HIPEC occurs more commonly in patients with extensive disease burden undergoing radical debulking, yet does not adversely influence surgical morbidity or survival. |
| Databáze: | OpenAIRE |
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