Is the "Birkmeyer Effect" Real for the Multimodal Treatment of Colorectal Cancer-Peritoneal Metastasis(CRC-PM)?

Şafak T., Manoğlu B., Sökmen S., Bişgin T., Güzel M.

31st BIENNIAL CONGRESS OF ISUCRS INTERNATIONAL SOCIETY OF UNIVERSITY COLON AND RECTAL SURGEONS, İstanbul, Türkiye, 27 - 29 Ekim 2022, ss.1

  • Yayın Türü: Bildiri / Tam Metin Bildiri
  • Basıldığı Şehir: İstanbul
  • Basıldığı Ülke: Türkiye
  • Sayfa Sayıları: ss.1
  • Dokuz Eylül Üniversitesi Adresli: Evet

Özet

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