31st BIENNIAL CONGRESS OF ISUCRS INTERNATIONAL SOCIETY OF UNIVERSITY COLON AND RECTAL SURGEONS, İstanbul, Türkiye, 27 - 29 Ekim 2022, ss.1
Is the ‘Birkmeyer Effect’ Real for the
Multimodal Treatment of Colorectal Cancer-Peritoneal Metastasis(CRC-PM)?
Berke Manoğlu1, Selman Sokmen1, Tayfun Bisgin1, Melek Güzel1, Funda Obuz2, Sevda Ozkardesler3
1Dokuz Eylül
University Medical Faculty, Dept. of Surgery, Colorectal&Pelvic Surgery,
Izmir
2Dokuz Eylül University Medical Faculty, Dept. of Radiology, Izmir
3Dokuz Eylül University Medical Faculty, Dept. of Aneshtesiology and
Surgical Intensive Care Unit, Izmir
Aims: The relation between surgeon volume and surgical morbi-mortality is
well-established(‘Birkmeyer effect’) for many complex cancer procedures.
This study is aimed to test this effect through the initial vs late period
results of our Peritoneal Surface Malignancy(PSM) center in treatment of CRC-PM
patients with Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal
Chemotheraphy(HIPEC) domain.
Materials-Methods: CRC-PM patients(n=212) treated with CRS&HIPEC were
analyzed from prospectively maintained database of PSM center. Two different
patient groups were created through 2007 to 2013(GI, n=79) and 2014 to
2020(GII, n=133) that were well-matched in terms of clinicopathologic
characteristics and intraoperative findings. Both groups’ postoperative
morbi-mortality results were evaluated.
Results: In this 2007 cohort, median age was 57 and 50% of patients was woman,
51% of patients had at least one comorbidity(n=108). There were 165 (78%)
patients with colon cancer-PM. The median follow-up of this series was 10
years.The median Peritoneal Cancer Index was 12 in GI and 9 in GII(p=0.002). No
significant association was found in comorbidity, neoadjuvan chemotherapy, SICU
care, operative time, stoma creation, and complete cytoreduction status. There
were no significant association in high grade Clavien-Dindo morbidity between
GI[10(13%)] and GII [20(15%)]. In contrast, strong association were revealed in
perioperative mortality between GI [10(12%)] and GII [5(3.8%)](p<0.001).
Length of Hospital stay was significantly decreased in GII(17days) when
compared with GI(24days)(p=0.001). There was no significant difference in
overall survival.
Conclusion: Surgical risks vary widely in complex cancer surgery. Our findings
strongly demonstrate that operative mortality is mediated by high-volume
surgeon. Heightened awareness, a better perioperative critical care, and
increased experience in technical complexity may improve surgical outcomes in
patients who are undergoing high-risk surgery.
Keywords: colorectal cancer, peritoneal metatasis, Birkmeyer Effect,
cytoreduction, HIPEC