Abstract
Background: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS–HIPEC) is a therapeutic approach used to achieve curative treatment in intra-abdominal malignancy with peritoneal carcinomatosis (PC). However, it is a complicated procedure with high post-operative complication rates. Thus, we analyzed our preliminary data to establish whether multidisciplinary teamwork (MDT) implementation is beneficial for CRS–HIPEC outcomes. Method: A series of 132 consecutive patients with synchronous or recurrent PC secondary to gastrointestinal or gynecologic cancer who received CRS–HIPEC operation between May 2015 and September 2017 were included. Ninety-nine patients were categorized into the MDT group, with the 33 other patients into the non-MDT group. Results: The mean PCI score was 16.3 ± 8.8. Patients in the MDT group more often presented a higher PCI score (p value = 0.038). Regarding CRS completeness (CCR 0–1), it was distributed 81.8% and 57.6% in the MDT and the non-MDT group, respectively (p value = 0.005). Although post-operative complications were common (n = 62, 47.0%), post-operative complication rates did not differ between the two groups. The cumulative OS survival rate at the first year was 75.5%. Older age (p = 0.030, HR = 4.58, 95% CI = 1.16–18.10), ECOG 2 (p = 0.030, HR = 6.41, 95% CI = 1.20–34.14), and incomplete cytoreduction (p = 0.048, HR = 2.79, 95% CI = 1.04–8.27) were independent prognostic factors for survival. Conclusions: Our experience suggests that the CRS–HIPEC performed under MDT cooperation may result in higher complete cytoreduction rates without increasing post-operative complications and hospital mortalities.
Highlights
Up to 5–20% of patients have been diagnosed with advanced intra-abdominal malignancies with peritoneal carcinomatosis (PC) at initial consultation due to lack of screening and a paucity of specific symptoms [1], with many suffering the consequences of a 6-months or less remaining lifespan [2]
This study enrolled a total of 132 patients who underwent cytoreductive surgery (CRS)–hyperthermic intraperitoneal chemotherapy (HIPEC) procedure with primary diagnoses of ovarian cancer (n = 60), colorectal cancer (n = 25), appendiceal cancer (n = 10), gastric cancer (n = 12), and other primary malignancies (n = 25), 6 for biliary cancer, 5 for uterus or uterine tube cancer, 3 for mesothelioma, 3 for pancreatic cancer, 3 for small bowel cancer, 2 for retroperitoneal malignancy, 1 for bladder cancer, 1 for prostate cancer, and 1 for primitive neural ectoderm malignancy)
The association between CRS–HIPEC operations and procedure initiators was investigated, showing that 60 cases were performed under the guidance of the general surgeons, while 56 and 16 cases were led by gyneco-oncologists and proctologists, respectively
Summary
Up to 5–20% of patients have been diagnosed with advanced intra-abdominal malignancies with peritoneal carcinomatosis (PC) at initial consultation due to lack of screening and a paucity of specific symptoms [1], with many suffering the consequences of a 6-months or less remaining lifespan [2]. In response to the complexity and diversification of cancer treatment, the role of the multidisciplinary team (MDT) has continually evolved in involving different professions to cooperate toward better therapeutic results, which has had a positive outcome [7,8]. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS–HIPEC) is a therapeutic approach used to achieve curative treatment in intra-abdominal malignancy with peritoneal carcinomatosis (PC). It is a complicated procedure with high post-operative complication rates. Patients in the MDT group more often presented a higher PCI score (p value = 0.038). Conclusions: Our experience suggests that the CRS–HIPEC performed under MDT cooperation may result in higher complete cytoreduction rates without increasing post-operative complications and hospital mortalities
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