HIPEC For Peritoneal Carcinomatosis Research Articles

Safety and feasibility of implementation of ERAS in CRS and HIPEC: Enhancing recovery or complications.

e18745 Background: We report our experience of implementation of ERAS protocol in patients undergoing CRS and HIPEC for peritoneal carcinomatosis. Methods: ERAS protocol for CRS± HIPEC was implemented in 90 patients from January 2021 to October 2022. We documented compliance rate and analysed the reason for non-compliance, effect of compliance on length of hospital stay, postoperative complications and readmission rate and compared the same with the 95 patients who had CRS HIPEC before adopting ERAS protocol from January 2019 to December 2020. Results: Of 185 patients in the study, 95 were in pre eras group and 90 in ERAS group. Demography, pre-operative and operative parameters were comparable between the groups. The average compliance rate achieved for entire cohort was 78.5%. Lowest compliance rates were seen for post-operative elements especially, early feeding and early mobilization. After implementation of ERAS, median length of hospital stay reduced from 12 to 9 days, length of ICU stay reduced from 4 to 2 days and postoperative complications sepsis reduced from 14.7% to 7%, respiratory complications 15.7% to 7%, surgical complications 10.5% to 2.9%, resurgery from 6.3% to 1.4% and in hospital mortality reduced from 5.3% to 1.4%. The ERAS group didn’t receive any long acting opioids, less usage of intraoperative crystalloids(7ml/kg/hr vs 13ml/kg/hr, p = 0.0001),early extubation and less readmission rates. Conclusions: The implementation of ERAS protocol is safe and feasible for CRS and HIPEC patients. Implementation of ERAS program has significantly reduced the length of hospital stay, length of ICU stay and postoperative morbidity.

Inflammatory biomarkers to predict postoperative infectious complications after cytoreductive surgery and HIPEC for peritoneal carcinomatosis

BackgroundEarly detection of postoperative infectious complications (IC) is crucial after Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). The aim of this study was to evaluate the predictive role of early postoperative inflammatory biomarkers level for the detection of postoperative IC. Methodsa retrospective study was performed including 199 patients treated with complete CRS/HIPEC for PC from various primary origins from September 2012 to January 2021. Patients were monitored by a routine measurement of inflammatory biomarkers (CRP, leukocytes, neutrophils, lymphocytes, neutrophile-to-lymphocyte ratio and platelets-to-lymphocyte ratio). Inflammatory biomarkers were compared between patients with vs without IC. ResultsIC occurred for 68 patients (34.2%). CRP values were significantly higher in patients with IC on POD 3, 5 and 7 (CRP = 166 mg/L [128–244], 155 mg/L [102–222] and 207 mg/L [135–259], respectively). The CRP on POD7, with a cut-off value of 100 mg/L, was an excellent predictor of postoperative IC (AUC = 90.1%). The CRP on POD 5, with a cut-off value of 90 mg/L, was a good predictor of postoperative IC (AUC = 83.2%). NLR values were significantly higher in patients with IC on POD 3, 5 and 7. NLR on POD 5 and 7 higher than 9.7 and 6.3, respectively, were fair predictors (AUC = 70.8 and 79.6, respectively). ConclusionCRP levels between POD3 and 7 are the best predictors of postoperative IC after CRS/HIPEC. The presence of postoperative IC should be suspected in patients with CRP higher than 140 mg/L, 90 mg/L or 100 mg/L on PODs 3, 5 or 7.

The Safety of Iterative Cytoreductive Surgery and HIPEC for Peritoneal Carcinomatosis: A High Volume Center Prospectively Maintained Database Analysis.

Offering iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for recurrence of peritoneal carcinomatosis (PC) poses a surgical dilemma. Safety of this repeatedoperation in the short and long term has not been largely investigated. Patients with PC who underwent 377 CRS/HIPEC procedures between 2007 and 2018 at our institution were included from a prospectively maintained database. Outcomes for patients who had singular CRS/HIPEC were compared with those forpatients who had repeated CRS/HIPEC. Overall, there were 325 singular and 52 iterative CRS/HIPEC procedures performed during this time period. Age, sex, and ASA class were comparable between cohorts (p = NS). Optimal cytoreduction, mean operative time, mean length of hospital stay, 90-day major morbidity, and 90-day mortality were also similar. At a median follow-up of 24months, there was no significant difference in recurrence rate (%, 60 vs 63, p = 0.76), disease-free survival (mean months, 19 vs 15, p = 0.30), and overall survival (mean months, 32 vs 27, p = 0.69). The iterative CRS/HIPEC group had significantly higher rates of major late complications than the singular CRS/HIPEC group (%, 18 vs 40, p < 0.01). Repeated CRS/HIPEC for PC has similar perioperative morbidity and mortality, as well as long-term oncological benefits, when compared with singular CRS/HIPEC. However, more than twice as many patients undergoing iterative CRS/HIPEC suffered from major late complications.

The use of Oxaliplatin or Mitomycin C in HIPEC treatment for peritoneal carcinomatosis from colorectal cancer: A comparative study

Oxaliplatin and Mitomycin C (MMC) are both suitable as intraperitoneal chemotherapy agents in HIPEC for peritoneal carcinomatosis (PC) of colorectal cancer (CRC). Patient cohorts from two different HIPEC-centers underwent cytoreductive surgery and HIPEC with Oxaliplatin (39 patients) and MMC (56 patients), respectively. They were compared for toxicity and survival data. The extent of PC was assessed using the Dutch 7-region count. The median 7-region count was 4 [range 0-7] for Oxaliplatin-patients versus 2.5 [range 1-6] for MMC-patients (P = 0.004). Median intra-operative blood loss was 650 ml [0-6,000 ml] in Oxaliplatin-patients versus 1,230 ml [range 0-5,300 ml] in MMC-patients (P < 0.001). Only MMC-patients developed neutropenia/leucopenia (26.8%, P < 0.001). After statistical correction for the extent of PC, the overall postoperative complication rate was significantly higher in MMC-patients (OR = 2.68 (95% CI: 1.04-6.91), P = 0.04), with a comparable intra-abdominal complication (IAC) rate (OR = 0.78 (95% CI: 0.30-2.03), P = 0.61), but a tendency towards more extra-abdominal complications (EAC) in MMC-patients (OR = 2.23 (95% CI: 0.91-5.43), P = 0.079). Median follow-up was significantly shorter for Oxaliplatin-patients (2.8 years) than for MMC-patients (5.1 years). Median RFS was 12.2 months [IQR: 7.2-undefined] in the Oxaliplatin-group and 13.8 months [IQR: 7.0-25.8] in the MMC-group (P = 0.87). Median OS is 37.1 months [IQR: 22.4-52.8] for Oxaliplatin-patients and 26.5 months [IQR: 16.9-64.8] for MMC-patients (P = 0.45). Logistic regression analysis (corrected for extent of PC) shows RFS (HR = 1.24 (95% CI: 0.75-2.05), P = 0.39) and OS (HR = 1.37 (95% CI: 0.74-2.54), P = 0.32) are not significantly different. No clear benefit in RFS and OS for HIPEC with Oxaliplatin or MMC could be demonstrated in patients with PC from CRC.

Postoperative infections after cytoreductive surgery and HIPEC for peritoneal carcinomatosis: Proposal and results from a prospective protocol study of prevention, surveillance and treatment

The incidence of infectious complications due to several contributory causes is particularly elevated and life-threatening in patients undergoing peritonectomy and HIPEC procedure for peritoneal carcinomatosis. Following a previous experience, we started a prospective protocol study of preoperative screening, perioperative prophylaxis and postoperative surveillance and treatment.A total of 111 patients with peritoneal carcinomatosis of various origin underwent CRS with HIPEC between April 2004 and December 2012. The group was divided into a pilot group of 30 patients (04/04 to 05/08) and a main group of 81 patients (06/08 to 12/12). Overall postoperative morbidity rate was 44%, with 35.8% of symptomatic infections. No post-operative mortality was observed. Microorganisms were isolated in 24 patients (80.0%) in the first group and 54 (66.7%) in the second. They were symptomatic in 18 cases (75.0%) and 25 (46.3%) cases respectively. In addition, 7 invasive candidosis were recorded (25.9%). Colon resection (P = 0.01) and duration of surgery (P = 0.0008) were associated with infection at logistic regression model. Concerning symptomatic infections, only Infection Risk Index (P = 0.009) showed significance at multivariate analysis.Despite a significant incidence of infectious complications, establishment of a prevention, surveillance and treatment protocol lead to a zero mortality rate in the observed patients of our experience. Owing to the obtained results, we suggest the use of a standardized protocol for the prevention, monitoring and treatment in all patients enrolled for cytoreductive surgery and HIPEC.

HIPEC ir citoredukcinių operacijų patirtis

Žurnalas „Sveikatos mokslai / Health sciences“ yra recenzuojamas tarptautinis mokslinis žurnalas, skirtas skleisti naujas žinias ir informaciją apie visuomenės sveikatą, sveikatos ugdymą, ligas, klinikinius tyrimus ir klinikinius atvejus, naujas technologijas, slaugą, reabilitaciją, sveikatos ekonomiką ir vadybą. Žurnalas spausdina mokslinius straipsnius lietuvių, anglų ir rusų kalbomis, kasmet išeina 1 tomas (6 numeriai) spausdintiniu ir elektroniniu variantais. Daugiau nei 140 mokslinių straipsnių publikuojami per metus. Žurnalas priklauso Lietuvos mokslo periodikos asociacijai.

HIPEC for Peritoneal Carcinomatosis: Does an Associated Urologic Procedure Increase Morbidity?

To report the incidence of urinary tract procedures performed during complete cytoreductive surgery (CCRS) plus intraperitoneal chemotherapy, and to report the types of procedure, specific morbidity, risk factors, and treatment. Data were extracted from a prospective database of patients with malignant peritoneal disease treated with CCRS plus intraperitoneal chemotherapy who had undergone a resection or suture of the bladder, ureter, or kidney. Patients were eligible whatever the tumor origin. Between 1994 and 2010, among the 598 patients treated with CCRS plus intraperitoneal chemotherapy, 48 (8%) had undergone a resection or suture in the urinary tract. Procedures included 4 nephrectomies, 19 partial cystectomies, 8 surgically repaired bladder injuries, and 18 ureteral resections. Postoperative mortality was 4% and morbidity was 41%. Specific complications included 6 urinary fistulas (12%), two among the 27 bladder sutures (7%) and four among the 18 ureteral sutures (22%) (P=NS). In the multivariate analysis, the risk factors for urinary fistula were severe preoperative malnutrition (P=0.05, relative risk [RR]=7.3) and extensive peritoneal disease (peritoneal cancer index ≥20, P=0.05, RR=8.3). Urinary fistulas had been treated nonsurgically in most of the cases. Associated urinary tract procedures had occurred in 8% of the cases but did not greatly increase morbidity. Therefore, urinary tract involvement or injury are not contraindications to performing CCRS plus intraperitoneal chemotherapy. Fistulas had complicated only 12% of urinary sutures, mainly in cases of malnutrition or extensive peritoneal disease.

Cytoreduction and HIPEC for Peritoneal Carcinomatosis from Colorectal Origin: The Amsterdam Experience

Cytoreduction and HIPEC for Peritoneal Carcinomatosis from Colorectal Origin: The Amsterdam Experience