Outcomes Following Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy with and without Diaphragmatic Resection in Patients with Peritoneal Metastases
| Autor: | Vadim Gushchin, Felipe Lopez-Ramirez, Ekaterina Baron, Carol Nieroda, Michelle Sittig, Andrei Nikiforchin, Armando Sardi |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Diaphragmatic breathing Subgroup analysis Hyperthermic Intraperitoneal Chemotherapy Gastroenterology Surgical oncology Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Humans Prospective Studies Peritoneal Neoplasms Retrospective Studies business.industry Retrospective cohort study Cytoreduction Surgical Procedures Hyperthermia Induced medicine.disease Combined Modality Therapy Survival Rate Appendiceal Neoplasms Oncology Conventional PCI Peritoneal Cancer Index Surgery Hyperthermic intraperitoneal chemotherapy Ovarian cancer business Follow-Up Studies |
| Zdroj: | Annals of Surgical Oncology. 29:873-882 |
| ISSN: | 1534-4681 1068-9265 |
| Popis: | Diaphragmatic resection (DR) is often required during cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) to achieve complete cytoreduction (CC). While CC provides the best survival, requiring a DR may indicate unfavorable tumor biology. We assessed how DR during CRS/HIPEC affects outcomes. A retrospective cohort study was conducted using a prospective single-center database from October 1994–May 2020. Peritoneal surface malignancy patients who underwent CRS/HIPEC with CC-0/1/2 were assigned to DR and NoDR groups. Survival was measured using the Kaplan–Meier method. Subgroup analysis was performed for patients with peritoneal cancer index (PCI) ≥ 20 to eliminate confounding of more extensive disease in DR. Of 824 CRS/HIPECs, 774 were included: 134 DR and 640 NoDR. PCI was significantly higher in DR: 29 versus 21, p < 0.001. CC-0/1 rate was 89% in DR and 95% in NoDR (p = 0.003). Neither 100-day morbidity nor mortality differed between the groups (p = 0.355 and p = 1.000). Median follow-up was 64 months. Median overall survival (OS) was significantly lower in DR (32 vs. 96 months, p < 0.001). Subgroup analysis by tumor type in patients with PCI ≥ 20 showed significantly shorter OS in DR than NoDR in appendiceal (40 vs. 196 months, p < 0.001) and colorectal (14 vs. 23 months, p = 0.003), but not in ovarian tumors (32 vs. 42 months, p = 0.893), whereas median PCI did not differ among subgroups. DR during CRS/HIPEC does not increase morbidity and mortality. It is associated with worse survival in appendiceal and colorectal tumors, even after adjusting for tumor burden but does not appear to impact ovarian cancer survival. |
| Databáze: | OpenAIRE |
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