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

Erscheinungsjahr:

2020

Erschienen:

2020

Enthalten in:

Zur Gesamtaufnahme - volume:220

Enthalten in:

American journal of surgery - 220(2020), 5 vom: 09. Nov., Seite 1235-1241

Sprache:

Englisch

Beteiligte Personen:

Sullivan, Brianne J [VerfasserIn]
Leigh, Natasha L [VerfasserIn]
Bekhor, Eliahu Y [VerfasserIn]
Carpiniello, Matthew [VerfasserIn]
Solomon, Daniel [VerfasserIn]
Magge, Deepa R [VerfasserIn]
Sarpel, Umut [VerfasserIn]
Golas, Benjamin J [VerfasserIn]
Labow, Daniel M [VerfasserIn]

Links:

Volltext

Themen:

Comparative Study
Cytoreductive surgery
Distal pancreatectomy
Journal Article
Peritoneal carcinomatosis

Anmerkungen:

Date Completed 04.01.2021

Date Revised 04.01.2021

published: Print-Electronic

Citation Status MEDLINE

doi:

10.1016/j.amjsurg.2020.06.045

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM312314736