Distal pancreatectomy in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy : Identifying risk and improving patient selection
Copyright © 2020 Elsevier Inc. All rights reserved..
BACKGROUND: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has become a principal tool in the management of peritoneal carcinomatosis (PC), but inclusion of pancreatic resection to obtain optimal debulking remains controversial.
METHODS: We performed a retrospective review of 419 patients with PC who underwent CRS/HIPEC. The patients were divided into two cohorts, those with distal pancreatectomy (DP) and those without (NP), and morbidity and survival outcomes were compared.
RESULTS: The DP cohort (n = 37) and the NP cohort (n = 371) had similar clinicopathologic characteristics (age, p = 0.596; gender, p = 0.328; ASA, p = 0.072). Operative time, number of organs resected, and EBL were greater in the DP cohort (<0.0001). A complete cytoreduction was achieved in 90% of the NP cohort versus 69% of the DP cohort (p = 0.0004). Major perioperative morbidity was more common in those with pancreatic resection (41% vs 19%, p = 0.002). However, there was no significant difference in 90-day mortality or overall survival.
CONCLUSION: Achieving complete cytoreduction is critical to improving long term outcomes for patients with PC. Although pancreatic resections are associated with higher morbidity, short-term survival is not impacted adversely. Pancreatic involvement should not be a strict exclusion criterion for CRS/HIPEC, but patients need to be selected carefully, with close attention to disease burden prior to proceeding.
Medienart: |
E-Artikel |
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Erscheinungsjahr: |
2020 |
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Erschienen: |
2020 |
Enthalten in: |
Zur Gesamtaufnahme - volume:220 |
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Enthalten in: |
American journal of surgery - 220(2020), 5 vom: 09. Nov., Seite 1235-1241 |
Sprache: |
Englisch |
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Beteiligte Personen: |
Sullivan, Brianne J [VerfasserIn] |
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Links: |
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Themen: |
Comparative Study |
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Anmerkungen: |
Date Completed 04.01.2021 Date Revised 04.01.2021 published: Print-Electronic Citation Status MEDLINE |
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doi: |
10.1016/j.amjsurg.2020.06.045 |
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funding: |
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Förderinstitution / Projekttitel: |
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PPN (Katalog-ID): |
NLM312314736 |
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500 | |a published: Print-Electronic | ||
500 | |a Citation Status MEDLINE | ||
520 | |a Copyright © 2020 Elsevier Inc. All rights reserved. | ||
520 | |a BACKGROUND: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has become a principal tool in the management of peritoneal carcinomatosis (PC), but inclusion of pancreatic resection to obtain optimal debulking remains controversial | ||
520 | |a METHODS: We performed a retrospective review of 419 patients with PC who underwent CRS/HIPEC. The patients were divided into two cohorts, those with distal pancreatectomy (DP) and those without (NP), and morbidity and survival outcomes were compared | ||
520 | |a RESULTS: The DP cohort (n = 37) and the NP cohort (n = 371) had similar clinicopathologic characteristics (age, p = 0.596; gender, p = 0.328; ASA, p = 0.072). Operative time, number of organs resected, and EBL were greater in the DP cohort (<0.0001). A complete cytoreduction was achieved in 90% of the NP cohort versus 69% of the DP cohort (p = 0.0004). Major perioperative morbidity was more common in those with pancreatic resection (41% vs 19%, p = 0.002). However, there was no significant difference in 90-day mortality or overall survival | ||
520 | |a CONCLUSION: Achieving complete cytoreduction is critical to improving long term outcomes for patients with PC. Although pancreatic resections are associated with higher morbidity, short-term survival is not impacted adversely. Pancreatic involvement should not be a strict exclusion criterion for CRS/HIPEC, but patients need to be selected carefully, with close attention to disease burden prior to proceeding | ||
650 | 4 | |a Comparative Study | |
650 | 4 | |a Journal Article | |
650 | 4 | |a Cytoreductive surgery | |
650 | 4 | |a Distal pancreatectomy | |
650 | 4 | |a Peritoneal carcinomatosis | |
700 | 1 | |a Leigh, Natasha L |e verfasserin |4 aut | |
700 | 1 | |a Bekhor, Eliahu Y |e verfasserin |4 aut | |
700 | 1 | |a Carpiniello, Matthew |e verfasserin |4 aut | |
700 | 1 | |a Solomon, Daniel |e verfasserin |4 aut | |
700 | 1 | |a Magge, Deepa R |e verfasserin |4 aut | |
700 | 1 | |a Sarpel, Umut |e verfasserin |4 aut | |
700 | 1 | |a Golas, Benjamin J |e verfasserin |4 aut | |
700 | 1 | |a Labow, Daniel M |e verfasserin |4 aut | |
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