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03-11-2022 | Peritonectomy | Original Article

Pelvic Peritonectomy Poorly Affects Outcomes in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Metastases

Authors: Eyal Mor, Dan Assaf, Shachar Laks, Efrat Keren Gilat, David Hazzan, Einat Shacham-Shmueli, Ofer Margalit, Naama Halpern, Tamar Beller, Ben Boursi, Ofer Purim, Daria Perelson, Douglas Zippel, Mohammad Adileh, Aviram Nissan, Almog Ben-Yaacov

Published in: Journal of Gastrointestinal Surgery | Issue 1/2023

Abstract

Background

Constraints of pelvic anatomy render complete cytoreduction (CRS) challenging. The aim of this study is to investigate the impact of pelvic peritonectomy during CRS/HIPEC on colorectal peritoneal metastasis (CRPM) patients’ outcomes.

Methods

This is a retrospective analysis of a prospectively maintained CRS/hyperthermic intraperitoneal chemotherapy (HIPEC) database. The analysis included 217 patients with CRPM who had a CRS/HIPEC between 2014 and 2021. We compared perioperative and oncological outcomes of patients with pelvic peritonectomy (PP) (n = 63) to no pelvic peritonectomy (non-PP) (n = 154).

Results

No differences in demographics were identified. The peritoneal cancer index (PCI) was higher in the PP group with a median PCI of 12 vs. 6 in the non-PP group (p < 0.001). Operative time was 4.9 vs. 4.3 h in the PP and non-PP groups, respectively (p = 0.63). Median hospitalization was longer in the PP group at 12 vs. 10 days (p = 0.007), and the rate of complications were higher in the PP group at 57.1% vs. 39.6% (p = 0.018).

Pelvic peritonectomy was associated with worse disease-free (DFS) and overall survival (OS) with 3-year DFS and OS of 7.3 and 46.3% in the PP group vs. 28.2 and 87.8% in the non-PP group (p = 0.028, p .> 0.001).

The univariate OS analysis identified higher PCI (p = 0.05), longer surgery duration (p = 0.02), and pelvic peritonectomy (p < 0.001) with worse OS. Pelvic peritonectomy remained an independent prognostic variable, irrespective of PCI, on the multivariate analysis (p < 0.001).

Conclusions

Pelvic peritonectomy at the time of CRS/HIPEC is associated with higher morbidity and worse oncological outcomes. These findings should be taken into consideration in the management of patients with pelvic involvement.

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Title: Pelvic Peritonectomy Poorly Affects Outcomes in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Metastases
Authors: Eyal Mor
Dan Assaf
Shachar Laks
Efrat Keren Gilat
David Hazzan
Einat Shacham-Shmueli
Ofer Margalit
Naama Halpern
Tamar Beller
Ben Boursi
Ofer Purim
Daria Perelson
Douglas Zippel
Mohammad Adileh
Aviram Nissan
Almog Ben-Yaacov
Publication date: 03-11-2022
Publisher: Springer US
Keywords: Peritonectomy
Surgery
Metastasis
Cytostatic Therapy
Published in: Journal of Gastrointestinal Surgery / Issue 1/2023
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-022-05501-y

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Springer Medicine

Pelvic Peritonectomy Poorly Affects Outcomes in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Metastases

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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