TY - JOUR
T1 - CRS/HIPEC with Major Organ Resection in Peritoneal Mesothelioma Does not Impact Major Complications or Overall Survival
T2 - A Retrospective Cohort Study of the US HIPEC Collaborative
AU - Roife, David
AU - Powers, Benjamin D.
AU - Zaidi, Mohammad Y.
AU - Staley, Charles A.
AU - Cloyd, Jordan M.
AU - Ahmed, Ahmed
AU - Grotz, Travis
AU - Leiting, Jennifer
AU - Fournier, Keith
AU - Lee, Andrew J.
AU - Veerapong, Jula
AU - Baumgartner, Joel M.
AU - Clarke, Callisia
AU - Patel, Sameer H.
AU - Hendrix, Ryan J.
AU - Lambert, Laura
AU - Abbott, Daniel E.
AU - Pokrzywa, Courtney
AU - Lee, Byrne
AU - Blakely, Andrew
AU - Greer, Jonathan
AU - Johnston, Fabian M.
AU - Laskowitz, Danielle
AU - Dessureault, Sophie
AU - Dineen, Sean P.
N1 - Publisher Copyright:
© 2020, Society of Surgical Oncology.
PY - 2020/12
Y1 - 2020/12
N2 - Introduction: CRS/HIPEC is thought to confer a survival advantage for patients with malignant peritoneal mesothelioma (MPM). However, the impact of nonperitoneal organ resection is not clearly defined. We evaluated the impact of major organ resection (MOR) on postoperative outcomes and overall survival (OS). Patients and Methods: The US HIPEC collaborative database (2000–2017) was reviewed for MPM patients who underwent CRS/HIPEC. MOR was defined as total or partial resection of diaphragm, stomach, spleen, pancreas, small bowel, colon, rectum, kidney, ureter, bladder, and/or uterus. MOR was categorized as 0, 1, or 2+ organs. Results: A total of 174 patients were identified. Median PCI was 16 (3–39). The distribution of patients with MOR-0, MOR-1, and MOR-2+ was 94, 45, and 35 patients, respectively. MOR-1 and MOR-2+ groups had a higher frequency of any complication compared with MOR-0 (57.8%, 74.3%, and 48.9%, respectively, p = 0.035), but Clavien 3/4 complications were similar. Median length of stay was slightly higher in the MOR-1 and MOR-2+ groups (10 and 11 days) compared with the MOR-0 cohort (9 days, p = 0.005). Incomplete cytoreduction, ASA class 4, and male gender were associated with increased mortality on unadjusted analysis; however, their impact on OS was attenuated on multivariable analysis. MOR was not associated with OS based on these data (MOR-1: HR 1.67, 95% CI 0.59–4.74; MOR-2+ : HR 0.77, 95% CI 0.22–2.69). Conclusions: MOR was not associated with an increase in major complications or worse OS in patients undergoing CRS/HIPEC for MPM and should be considered, if necessary, to achieve complete cytoreduction for MPM patients.
AB - Introduction: CRS/HIPEC is thought to confer a survival advantage for patients with malignant peritoneal mesothelioma (MPM). However, the impact of nonperitoneal organ resection is not clearly defined. We evaluated the impact of major organ resection (MOR) on postoperative outcomes and overall survival (OS). Patients and Methods: The US HIPEC collaborative database (2000–2017) was reviewed for MPM patients who underwent CRS/HIPEC. MOR was defined as total or partial resection of diaphragm, stomach, spleen, pancreas, small bowel, colon, rectum, kidney, ureter, bladder, and/or uterus. MOR was categorized as 0, 1, or 2+ organs. Results: A total of 174 patients were identified. Median PCI was 16 (3–39). The distribution of patients with MOR-0, MOR-1, and MOR-2+ was 94, 45, and 35 patients, respectively. MOR-1 and MOR-2+ groups had a higher frequency of any complication compared with MOR-0 (57.8%, 74.3%, and 48.9%, respectively, p = 0.035), but Clavien 3/4 complications were similar. Median length of stay was slightly higher in the MOR-1 and MOR-2+ groups (10 and 11 days) compared with the MOR-0 cohort (9 days, p = 0.005). Incomplete cytoreduction, ASA class 4, and male gender were associated with increased mortality on unadjusted analysis; however, their impact on OS was attenuated on multivariable analysis. MOR was not associated with OS based on these data (MOR-1: HR 1.67, 95% CI 0.59–4.74; MOR-2+ : HR 0.77, 95% CI 0.22–2.69). Conclusions: MOR was not associated with an increase in major complications or worse OS in patients undergoing CRS/HIPEC for MPM and should be considered, if necessary, to achieve complete cytoreduction for MPM patients.
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U2 - 10.1245/s10434-020-09232-9
DO - 10.1245/s10434-020-09232-9
M3 - Article
C2 - 33073341
AN - SCOPUS:85092651782
SN - 1068-9265
VL - 27
SP - 4996
EP - 5004
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 13
ER -