Learning Curve for Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Peritoneal Surface Malignancy—A Journey to Becoming a Nationally Funded Peritonectomy Center (original) (raw)

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Abstract

Background

Cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) for peritoneal surface malignancy is associated with a morbidity rate of 30–50% and a mortality rate of 1–10%. Recently, the St George Hospital in Sydney has been commissioned as the Nationally Funded Center for treatment of peritoneal surface malignancy in Australia.

Methods

The clinical and treatment-related data regarding 140 consecutive patients were prospectively collected. A comparison between the initial 70 patients (Group I) and the subsequent 70 patients (Group II) was performed. Univariate and multivariate analyses were conducted to identify the significant risk factors for moderate to severe morbidity.

Results

The hospital mortality was 4%. Sixty-one patients (44%) had moderate morbidity. Twenty-eight patients (20%) experienced severe morbidity. The mean hospital stay was 30 days. Twenty-seven patients (19%) were readmitted after initial discharge for management of delayed complications. The severe morbidity rate reduced from 30% to 10%, and the delayed morbidity rate reduced from 29% to 10%, when comparing Groups I and II. There were also reduced transfusion requirement, duration of operation, and intensive care unit stay. In the multivariate analysis, Group I (vs Group II; P = .005), performing small bowel resection (P = .005), and >4 peritonectomy procedures (vs ≤ 4; P = .013) were the three independent risk factors for severe complications.

Conclusions

The study suggests that there is a learning curve associated with this procedure. With accumulated experience in this procedure, an acceptable morbidity rate can be achieved.

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References

  1. Gonzalez-Moreno S. Peritoneal Surface Oncology: A progress report. Eur J Surg Oncol 2006;32:593–6
    Article PubMed Google Scholar
  2. Yan TD, Black D, Savady R, Sugarbaker PH. A systematic review on the efficacy of cytoreductive surgery and perioperative intraperitoneal chemotherapy for pseudomyxoma peritonei. Ann Surg Oncol 2007;14:484–9
    Article PubMed Google Scholar
  3. Yan TD, Black D, Savady R, Sugarbaker PH. Systematic review on the efficacy of cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal carcinoma. J Clin Oncol 2006;24:4011–9
    Article PubMed Google Scholar
  4. Yan TD, Welch L, Black D, Sugarbaker P. A systematic review on the efficacy of cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for diffuse malignancy peritoneal mesothelioma. Ann Oncol 2006;DOI:10.1093/annonc/mdl428
  5. Moran BJ. Establishment of a peritoneal malignancy treatment centre in the United Kingdom. Eur J Surg Oncol 2006;32:614–8
    Article PubMed Google Scholar
  6. Deraco M, Nonaka D, Baratti D, et al. Prognostic analysis of clinicopathologic factors in 49 patients with diffuse malignant peritoneal mesothelioma treated with cytoreductive surgery and intraperitoneal hyperthermic perfusion. Ann Surg Oncol 2006;13:229–37
    Article PubMed Google Scholar
  7. Smeenk RM, Verwaal VJ, Antonini N, Zoetmulder FA. Progression of pseudomyxoma peritonei after combined modality treatment: management and outcome. Ann Surg Oncol 2007;14:493–9
    Article PubMed Google Scholar
  8. Verwaal VJ, van Ruth S, de Bree E, et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol 2003;21:3737–43
    Article PubMed Google Scholar
  9. Loungnarath R, Causeret S, Bossard N, et al. Cytoreductive surgery with intraperitoneal chemohyperthermia for the treatment of pseudomyxoma peritonei: a prospective study. Dis Colon Rectum 2005;48:1372–9
    Article PubMed Google Scholar
  10. Bradley RF, Stewart JH, Russell GB, et al. Pseudomyxoma peritonei of appendiceal origin: a clinicopathologic analysis of 101 patients uniformly treated at a single institution, with literature review. Am J Surg Pathol 2006;30:551–9
    Article PubMed Google Scholar
  11. Yan TD, Links M, Xu ZY, et al. Cytoreductive surgery and perioperative intraperitoneal chemotherapy for pseudomyxoma peritonei from appendiceal mucinous neoplasms. Br J Surg 2006;93:1270–6
    Article PubMed CAS Google Scholar
  12. Sugarbaker PH. New standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome? Lancet Oncol 2006;7:69–76
    Article PubMed Google Scholar
  13. Younan R, Kusamura S, Baratti D, et al. Bowel complications in 203 cases of peritoneal surface malignancies treated with peritonectomy and closed-technique intraperitoneal hyperthermic perfusion. Ann Surg Oncol 2005;12:910–8
    Article PubMed Google Scholar
  14. Yan TD, Alderman R, Edwards G, Sugarbaker P. Morbidity and mortality assessment of cytoreductive surgery and perioperative intraperitoneal chemotherapy for diffuse malignant peritoneal mesothelioma—a prospective study of 70 consecutive cases. Ann Surg Oncol 2007;14:515–5
    Article PubMed Google Scholar
  15. Sugarbaker PH, Alderman R, Edwards G, et al. Prospective morbidity and mortality assessment of cytoreductive surgery plus perioperative intraperitoneal chemotherapy to treat peritoneal dissemination of appendiceal mucinous malignancy. Ann Surg Oncol 2006;13:635–44
    Article PubMed Google Scholar
  16. Smeenk RM, Verwaal VJ, Zoetmulder FA. Toxicity and mortality of cytoreduction and intraoperative hyperthermic intraperitoneal chemotherapy in pseudomyxoma peritonei—a report of 103 procedures. Eur J Surg Oncol 2006;32:186–90
    Article PubMed CAS Google Scholar
  17. Moran BJ, Mukherjee A, Sexton R. Operability and early outcome in 100 consecutive laparotomies for peritoneal malignancy. Br J Surg 2006;93:100–4
    Article PubMed CAS Google Scholar
  18. Glehen O, Osinsky D, Cotte E, et al. Intraperitoneal chemohyperthermia using a closed abdominal procedure and cytoreductive surgery for the treatment of peritoneal carcinomatosis: morbidity and mortality analysis of 216 consecutive procedures. Ann Surg Oncol 2003;10:863–9
    Article PubMed CAS Google Scholar
  19. Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treatment Res 1996;82:359–74
    CAS Google Scholar
  20. Sugarbaker PH. Peritonectomy procedures Ann Surg 1995;221:29–42
    Article PubMed CAS Google Scholar
  21. Esquivel J, Vidal-Jove J, Steves MA, Sugarbaker PH. Morbidity and mortality of cytoreductive surgery and intraperitoneal chemotherapy. Surgery 1993;113:631–6
    PubMed CAS Google Scholar
  22. Sugarbaker PH, Jablonski KA. Prognostic features of 51 colorectal and 130 appendiceal cancer patients with peritoneal carcinomatosis treated by cytoreductive surgery and intraperitoneal chemotherapy. Ann Surg 1995;221:124–32
    Article PubMed CAS Google Scholar
  23. Jacquet P, Stephens AD, Averbach AM, et al. Analysis of morbidity and mortality in 60 patients with peritoneal carcinomatosis treated by cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy. Cancer 1996;77:2622–9
    Article PubMed CAS Google Scholar
  24. Stephens AD, Alderman R, Chang D, et al. Morbidity and mortality analysis of 200 treatments with cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy using the coliseum technique. Ann Surg Oncol 1999;6:790–6
    Article PubMed CAS Google Scholar
  25. Yan TD, Alderman R, Edwards G, Sugarbaker P. Morbidity and mortality assessment of cytoreductive surgery and perioperative intraperitoneal chemotherapy for diffuse malignant peritoneal mesothelioma—a prospective study of 70 consecutive cases. Ann Surg Oncol 2007; 15:515–25
    Article Google Scholar
  26. Department of Health (UK) 2002, National Specialist Commission Advisory Group Annual Report 2001–2002, DH Publications, London
    Google Scholar

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ACKNOWLEDGMENTS

The authors indicate that there are no potential conflicts of interests. Authors thank Jing Zhao, MD, for maintaining the peritonectomy database.

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Authors and Affiliations

  1. Nationally Funded Peritonectomy Center, Department of Surgery, University of New South Wales, Sydney, NSW, Australia
    Tristan D. Yan BSc (Med) MBBS, Vanessa Saunders BNMN & David L. Morris MD PhD
  2. Department of Medical Oncology, St George Hospital, Sydney, NSW, Australia
    Matthew Links MBBS PhD
  3. Department of Anesthesiology, St George Hospital, Sydney, NSW, Australia
    Sal Fransi MBBS
  4. Intensive Care Unit, St George Hospital, Sydney, NSW, Australia
    Theresa Jacques MBBS
  5. School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
    Deborah Black BSc DipEd MStat PhD

Authors

  1. Tristan D. Yan BSc (Med) MBBS
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  2. Matthew Links MBBS PhD
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  3. Sal Fransi MBBS
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  4. Theresa Jacques MBBS
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  5. Deborah Black BSc DipEd MStat PhD
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  6. Vanessa Saunders BNMN
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  7. David L. Morris MD PhD
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Corresponding author

Correspondence toDavid L. Morris MD PhD.

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Yan, T.D., Links, M., Fransi, S. et al. Learning Curve for Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Peritoneal Surface Malignancy—A Journey to Becoming a Nationally Funded Peritonectomy Center.Ann Surg Oncol 14, 2270–2280 (2007). https://doi.org/10.1245/s10434-007-9406-8

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