Akademik Veri Yönetim Sistemi
The 12th International Congress on Peritoneal Surface Malignancies Beijing, China, Beijing, Çin, 10 - 12 Ekim 2021, ss.277-278
Background:
Cytoreductive
surgery(CRS) with hyperthermic intraperitoneal chemotherapy(HIPEC) has become
the treatment of choice for resectable peritoneal metastasis(PM) to improve the
overall survival of these patients. It’s so difficult to predict how the morbi-mortality
results and oncologic outcomes will be in repeated CRS(re-CRS).
Objectives:
To
evaluate the surgical and oncologic outcomes of primary CRS&HIPEC and re-CRS&HIPEC.
Methods: Prospectively
maintained database of 661 PM patients treated with potentially curative intent
CRS&HIPEC thorough the years of 2007 and 2020 was evaluated. Re-cytoreductive surgery was performed in
51 of them. Seven of these patients underwent CRS for the third time. The median age was 54 (ranging, 16-76) years
and 72.5 % of the patients was female. The most common primaries were ovarian(39.2%)
and colorectal(37.2%) tumors. The median Peritoneal Cancer Index(PCI) was 7
(ranging, 3-21) and 84.3% of the patients underwent CC-0. All
standart clinico-pathological characteristics, re-operative findings, morbi-mortality
results, and final oncologic outcomes were reviewed and were compared with those
of patients who had primary CRS&HIPEC.
Results: The
median operating time was 300 minutes(range, 120–570) and 305 minutes(ranging,
120–650) during the primary CRS and re-CRS. While less than five organs were
resected in 82.7%(n=42) of the patients who underwent primary CRS, it was
84.3%(n=43) for the patients who underwent re-CRS. The median length of hospital stay(LoHS) after primary
CRS and re-CRS were 15 days(ranging, 4-48) and 12 days(ranging, 5-90), respectively.
The
morbidity rates were 31.3%(n=16) and 7.8%(n=4), respectively. The
high grade morbidity rate was lower in re-CRS group(grade III-IV 21.5% vs 7.8%).
The mortality rates were similar in between the patients who underwent primary
CRS(5.8%) and re-CRS(5.8%). When the patients who underwent CRS for the third
time were compared with patients who underwent re-CRS, no significant
difference was found in terms of surgical outcomes. The
patients in the group who underwent re-CRS had significantly shorter mean
hospital(LoHS)(p<0.05) and lower postoperative high grade
morbidity(p<0.05) than the patients in the group who underwent primary CRS.
The overall survival of the patients in the primary CRS group was 81.29 months,
whereas it was 79.77 months in the re-CRS group. The
3- and 5-year survival rates were lower in re-CRS group(17% and 5% vs 22% and
11%), respectively.
Conclusions: Re-CRS
and HIPEC can be safely and effectively performed with acceptable
morbi-mortality results and oncologic outcomes in carefully selected and
intensely followed-up PM patients at experienced centers.
Key words: Repeated cytoreductive surgery, hyperthermic
intraperitoneal chemotherapy, peritoneal metastasis.