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01-01-2020 | Peritoneal Cancer | Peritoneal Surface Malignancy

Diaphragmatic Peritoneal Stripping Versus Full-Thickness Resection in CRS/HIPEC: Is There a Difference?

Authors: Brianne J. Sullivan, MD, Eliahu Y. Bekhor, MD, Matthew Carpiniello, MD, Natasha L. Leigh, MD, Eric R. Pletcher, MD, Daniel Solomon, MD, Deepa R. Magge, MD, Umut Sarpel, MD, Daniel M. Labow, MD, Benjamin J. Golas, MD

Published in: Annals of Surgical Oncology | Issue 1/2020

Abstract

Background

Pleural recurrence after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is rare and poorly delineated. Specifically, data are limited on the effect that diaphragmatic peritoneal stripping versus full-thickness resection has on the nature of ipsilateral pleural recurrence and postoperative morbidity.

Methods

Patients with peritoneal carcinomatosis who underwent CRS/HIPEC were included from a prospectively maintained database. The patients were divided into three cohorts based on surgical management of the diaphragm as follows: diaphragm-stripping (DS) cohort, full-thickness resection (FTR) cohort, and no diaphragm manipulation (ND) cohort. Postoperative morbidity and incidence of ipsilateral pleural recurrence were evaluated. All diaphragmatic defects were closed before abdominal chemoperfusion.

Results

The inclusion criteria were met by 409 CRS/HIPEC procedures: 66 in DS, 122 in FTR, and 238 in ND. Ipsilateral pleural recurrence rates did not differ significantly between the three cohorts (DS 6%, FTR 3%, ND 3%; p = 0.470). Postoperative respiratory complications and overall morbidity were significantly greater for the patients who underwent diaphragmatic disruption (stripping and/or resection) than for the patients who did not (p ≤ 0.0001), but the two groups did not differ in terms of 30-day mortality. However, comparison of FTR with DS showed no impact on major morbidity or pleural recurrence.

Conclusion

Although patients undergoing surgical manipulation of the diaphragm during CRS/HIPEC experienced significantly greater morbidity, diaphragmatic stripping did not differ from full-thickness resection in terms of grades 3 and 4 complications or incidence of ipsilateral pleural recurrences. When deemed necessary to achieve complete cytoreduction, full-thickness diaphragmatic resection should be undertaken. In addition, the data support the observation that definitive repair of the diaphragmatic defect before abdominal chemoperfusion does not adversely influence ipsilateral pleural recurrence.

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Title: Diaphragmatic Peritoneal Stripping Versus Full-Thickness Resection in CRS/HIPEC: Is There a Difference?
Authors: Brianne J. Sullivan, MD
Eliahu Y. Bekhor, MD
Matthew Carpiniello, MD
Natasha L. Leigh, MD
Eric R. Pletcher, MD
Daniel Solomon, MD
Deepa R. Magge, MD
Umut Sarpel, MD
Daniel M. Labow, MD
Benjamin J. Golas, MD
Publication date: 01-01-2020
Publisher: Springer International Publishing
Keywords: Peritoneal Cancer
Peritoneal Carcinomatosis
Published in: Annals of Surgical Oncology / Issue 1/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-019-07797-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Diaphragmatic Peritoneal Stripping Versus Full-Thickness Resection in CRS/HIPEC: Is There a Difference?

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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