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Sitoredüktif cerrahi ve CC/0 rezeksiyonla hipertermik intraperitoneal kemoterapi uygulanan hastalarda distal pankreatektomi ve splenektominin sonuçlara etkisi

Yıl 2021, Cilt: 20 Sayı: 2, 104 - 111, 26.08.2021
https://doi.org/10.17941/agd.978955

Öz

Giriş ve Amaç: Bu çalışmanın amacı, peritoneal karsinomatozis nedeniyle sitoredüktif cerrahi ve hipertermik intraperitoneal kemoterapi uygulanan ve komplet sitoredüksiyon sağlanan hastalarda distal pankreatektomi+splenektominin erken ve geç postoperatif etkilerini belirlemektir. Gereç ve Yöntem: Kliniğimizde 2014-2020 yılları arasında çeşitli tümörlerin peritoneal karsinomatozisi nedeniyle sitoredüktif cerrahi ve hipertermik intraperitoneal kemoterapi işlemi yapılan tüm hastalar çalışmaya dahil edildi. Ek distal pankreatektomi ve splenektomi yapılan tüm hastaların verileri retrospektif olarak analiz edildi. Bulgular: Peritoneal karsinomatozis tanısıyla ameliyat edilen 136 hastanın 85'ine (komplet sitoredüksiyon rezeksiyonla) sitoredüktif cerrahi ve hipertermik intraperitoneal kemoterapi işlemi uygulandı. Bu hastaların 13’ünün (%15.3) ana işlemle birlikte distal pankreatektomi + splenektomi geçirdiği değerlendirildi. Distal pankreatektomi ve splenektomi yapılan hastalarda ortalama yatış süresi 15 (5-50) gün iken, yapılmayanlarda 13 (4-109) gündü ve aradaki fark istatistiksel olarak anlamsızdı. Distal pankreatektomi ve splenektomi yapılan grupta en sık görülen majör komplikasyon anastomoz kaçağı, enterokutanöz fistül ve intraabdominal apse idi. 30 günlük mortalite distal pankreatektomi ve splenektomi eklenen ve eklenmeyen gruplarda sırası ile 2 (%15.38) ve 1 (%1.38) idi. Gruplar değerlendirildiğinde; medyan sağkalım süresi sitoredüktif cerrahi ve hipertermik intraperitoneal kemoterapi grubunda 19 ay, sitoredüktif cerrahi ve hipertermik intraperitoneal kemoterapi + distal pankreatektomi ve splenektomili grupta 18 aydı ve istatistiksel olarak anlamlı değildi (p = 0.382). Sonuç: Distal pankreatektomi ve splenektomi eklenmesi, sitoredüktif cerrahi ve hipertermik intraperitoneal kemoterapi uygulanan hastalarda postoperatif majör komplikasyonları arttırmaktadır, fakat genel ortalama sağkalımı etkilememiştir. Tam bir sitoredüksiyon için gerekirse distal pankreatektomi ve splenektomi yapılabileceğini düşünüyoruz ancak bu işlemin postoperatif majör komplikasyonların gelişimini arttırdığı bilinmeli ve buna göre hasta takibi yapılmalıdır.

Kaynakça

  • 1. Yoo HJ, Hong JJ, Ko YB et al. Current practices of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal surface malignancies: an international survey of oncologic surgeons. World J Surg Oncol 2018;16:92.
  • 2. Goéré D, Malka D, Tzanis D, et al. Is there a possibility of a cure in patients with colorectal peritoneal carcinomatosis amenable to complete cytoreductive surgery and intraperitoneal chemotherapy? Ann Surg 2013;257:1065-71.
  • 3. Chia CS, You B, Decullier E, et al; BIG RENAPE Group. Patients with peritoneal carcinomatosis from gastric cancer treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Is cure a possibility? Ann Surg Oncol 2016;23:1971-9.
  • 4. Spiliotis J, Halkia E, Lianos E, et al. Cytoreductive surgery and HIPEC in recurrent epithelial ovarian cancer: a prospective randomized phase III study. Ann Surg Oncol 2015;22:1570-5.
  • 5. Benhaim L, Faron M, Gelli M, et al. Survival after complete cytoreductive surgery and HIPEC for extensive pseudomyxoma peritonei. Surg Oncol 2019;29:78-83.
  • 6. Li Y, Yu Y, Liu Y. Report on the 9(th) International Congress on Peritoneal Surface Malignancies. Cancer Biol Med. 2014;11:281-4.
  • 7. Dodson RM, Kuncewitch M, Votanopoulos KI, et al. Techniques for cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol 2018;25:2152-8.
  • 8. Huang CQ, Min Y, Wang SY, et al. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy improves survival for peritoneal carcinomatosis from colorectal cancer: a systematic review and meta-analysis of current evidence. Oncotarget 2017;8:55657-83.
  • 9. Simkens GA, van Oudheusden TR, Luyer MD, et al. Serious postoperative complications affect early recurrence after cytoreductive surgery and HIPEC for colorectal peritoneal carcinomatosis. Ann Surg Oncol 2015;22:2656-62.
  • 10. Sugarbaker PH, Editor. Cytoreductive surgery & perioperative chemotherapy for peritoneal surface malignancy. Textbook and video atlas. Woodbury: CineMed Publishing; 2012.
  • 11. Oken MM, Creech RH, Tormey DC, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982;5:649-55.
  • 12. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z; Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 2003;22:321-36.
  • 13. Sugarbaker PH. Peritonectomy procedures. Surg Oncol Clin N Am 2003;12:703-27.
  • 14. Baratti D, Kusamura S, Mingrone E, et al. Identification of a subgroup of patients at highest risk for complications after surgical cytoreduction and hyperthermic intraperitoneal chemotherapy. Ann Surg 2012;256:334-41.
  • 15. Glehen O, Kwiatkowski F, Sugarbaker PH, et al. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol 2004;22:3284-92.
  • 16. Elias D, Goéré D, Dumont F, et al. Role of hyperthermic intraoperative peritoneal chemotherapy in the management of peritoneal metastases. Eur J Cancer 2014;50:332-40.
  • 17. Bonnot PE, Piessen G, Kepenekian V, et al; FREGAT and BIG-RENAPE Networks. Cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy for gastric cancer with peritoneal metastases (CYTO-CHIP study): A propensity score analysis. J Clin Oncol 2019;37:2028-40.
  • 18. Spiliotis J, Halkia E, de Bree E. Treatment of peritoneal surface malignancies with hyperthermic intraperitoneal chemotherapy-current perspectives. Curr Oncol 2016;23:266-75.
  • 19. Deraco M, Kusamura S, Corbellini C, et al. Treatment principles for peritoneal surface malignancies. Minerva Chir 2016;71:124-45.
  • 20. Bao P, Bartlett D. Surgical techniques in visceral resection and peritonectomy procedures. Cancer J 2009;15:204-11.
  • 21. Berger Y, Aycart S, Mandeli JP et al. Extreme cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Outcomes from a single tertiary center. Surg Oncol 2015;24:264-9.
  • 22. Piso P, Nedelcut SD, Rau B et al. Morbidity and mortality following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Data from the DGAV StuDoQ Registry with 2149 consecutive patients. Ann Surg Oncol 2019;26:148-54.
  • 23. Kusamura S, Younan R, Baratti D, et al. Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion: analysis of morbidity and mortality in 209 peritoneal surface malignancies treated with closed abdomen technique. Cancer 2006;106:1144-53.
  • 24. Mehta SS, Gelli M, Agarwal D, Goéré D. Complications of cytoreductive surgery and HIPEC in the treatment of peritoneal metastases. Indian J Surg Oncol 2016;7:225-9.
  • 25. Deraco M, Baratti D, Kusamura S, Laterza B, Balestra MR. Surgical technique of parietal and visceral peritonectomy for peritoneal surface malignancies. J Surg Oncol 2009;100:321-8.
  • 26. Downs-Canner S, Ding Y, Magge DR, et al. A comparative analysis of postoperative pancreatic fistulas after surgery with and without hyperthermic intraperitoneal chemoperfusion. Ann Surg Oncol 2015;22:1651-7.
  • 27. Schwarz L, Votanopoulos K, Morris D, et al. Is the combination of distal pancreatectomy and cytoreductive surgery with HIPEC reasonable?: Results of an international multicenter study. Ann Surg 2016;263:369-75.
  • 28. Doud AN, Randle RW, Clark CJ, et al. Impact of distal pancreatectomy on outcomes of peritoneal surface disease treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol 2015;22:1645-50.
  • 29. Sullivan BJ, Leigh NL, Bekhor EY, et al. Distal pancreatectomy in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: Identifying risk and improving patient selection. Am J Surg 2020;220:1235-41.

Effects of distal pancreatectomy and splenectomy on outcomes in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with CC/0 resection

Yıl 2021, Cilt: 20 Sayı: 2, 104 - 111, 26.08.2021
https://doi.org/10.17941/agd.978955

Öz

Background and Aim: This study aims to determine the early and late postoperative effects of distal pancreatectomy plus splenectomy in patients who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy and achieved CC0 resection due to peritoneal carcinomatosis. Material and Method: All patients who underwent a cytoreductive surgery and hyperthermic intraperitoneal chemotherapy procedure due to peritoneal carcinomatosis of various tumors in our clinic between 2014 and 2020 were included in the study. Data from all patients who underwent additional distal pancreatectomy plus splenectomy were analyzed retrospectively. Results: The cytoreductive surgery and hyperthermic intraperitoneal chemotherapy procedure with CC/0 resection was performed on 85 of 136 patients diagnosed with peritoneal carcinomatosis. Of these patients, 13 (15.3%) had undergone distal pancreatectomy plus splenectomy together with the main procedure. The mean hospital stay was 15 (range, 5–50) days in patients who underwent distal pancreatectomy plus splenectomy, whereas it was 13 (range, 4–109) days in those who did not, and the difference was statistically insignificant. The most common major complications seen in the distal pancreatectomy plus splenectomy group were an anastomotic leak, enterocutaneous fistula, and intraabdominal abscess. The 30-day mortality was two (15.38%) and one (1.38%) in the group with and the group without distal pancreatectomy plus splenectomy, respectively. When the groups were evaluated, the median survival time was 19 months in the cytoreductive surgery and hyperthermic intraperitoneal chemotherapy group and 18 months in the cytoreductive surgery and hyperthermic intraperitoneal chemotherapy + distal pancreatectomy plus splenectomy group. This difference was statistically insignificant (p = 0.382). Conclusion: The addition of distal pancreatectomy plus splenectomy increased major postoperative complications in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy but did not affect overall survival. We think distal pancreatectomy plus splenectomy can be performed for a complete cytoreduction if necessary. However, it increases major postoperative complications, and patient follow-up should be done accordingly.

Kaynakça

  • 1. Yoo HJ, Hong JJ, Ko YB et al. Current practices of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal surface malignancies: an international survey of oncologic surgeons. World J Surg Oncol 2018;16:92.
  • 2. Goéré D, Malka D, Tzanis D, et al. Is there a possibility of a cure in patients with colorectal peritoneal carcinomatosis amenable to complete cytoreductive surgery and intraperitoneal chemotherapy? Ann Surg 2013;257:1065-71.
  • 3. Chia CS, You B, Decullier E, et al; BIG RENAPE Group. Patients with peritoneal carcinomatosis from gastric cancer treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Is cure a possibility? Ann Surg Oncol 2016;23:1971-9.
  • 4. Spiliotis J, Halkia E, Lianos E, et al. Cytoreductive surgery and HIPEC in recurrent epithelial ovarian cancer: a prospective randomized phase III study. Ann Surg Oncol 2015;22:1570-5.
  • 5. Benhaim L, Faron M, Gelli M, et al. Survival after complete cytoreductive surgery and HIPEC for extensive pseudomyxoma peritonei. Surg Oncol 2019;29:78-83.
  • 6. Li Y, Yu Y, Liu Y. Report on the 9(th) International Congress on Peritoneal Surface Malignancies. Cancer Biol Med. 2014;11:281-4.
  • 7. Dodson RM, Kuncewitch M, Votanopoulos KI, et al. Techniques for cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol 2018;25:2152-8.
  • 8. Huang CQ, Min Y, Wang SY, et al. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy improves survival for peritoneal carcinomatosis from colorectal cancer: a systematic review and meta-analysis of current evidence. Oncotarget 2017;8:55657-83.
  • 9. Simkens GA, van Oudheusden TR, Luyer MD, et al. Serious postoperative complications affect early recurrence after cytoreductive surgery and HIPEC for colorectal peritoneal carcinomatosis. Ann Surg Oncol 2015;22:2656-62.
  • 10. Sugarbaker PH, Editor. Cytoreductive surgery & perioperative chemotherapy for peritoneal surface malignancy. Textbook and video atlas. Woodbury: CineMed Publishing; 2012.
  • 11. Oken MM, Creech RH, Tormey DC, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982;5:649-55.
  • 12. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z; Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 2003;22:321-36.
  • 13. Sugarbaker PH. Peritonectomy procedures. Surg Oncol Clin N Am 2003;12:703-27.
  • 14. Baratti D, Kusamura S, Mingrone E, et al. Identification of a subgroup of patients at highest risk for complications after surgical cytoreduction and hyperthermic intraperitoneal chemotherapy. Ann Surg 2012;256:334-41.
  • 15. Glehen O, Kwiatkowski F, Sugarbaker PH, et al. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol 2004;22:3284-92.
  • 16. Elias D, Goéré D, Dumont F, et al. Role of hyperthermic intraoperative peritoneal chemotherapy in the management of peritoneal metastases. Eur J Cancer 2014;50:332-40.
  • 17. Bonnot PE, Piessen G, Kepenekian V, et al; FREGAT and BIG-RENAPE Networks. Cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy for gastric cancer with peritoneal metastases (CYTO-CHIP study): A propensity score analysis. J Clin Oncol 2019;37:2028-40.
  • 18. Spiliotis J, Halkia E, de Bree E. Treatment of peritoneal surface malignancies with hyperthermic intraperitoneal chemotherapy-current perspectives. Curr Oncol 2016;23:266-75.
  • 19. Deraco M, Kusamura S, Corbellini C, et al. Treatment principles for peritoneal surface malignancies. Minerva Chir 2016;71:124-45.
  • 20. Bao P, Bartlett D. Surgical techniques in visceral resection and peritonectomy procedures. Cancer J 2009;15:204-11.
  • 21. Berger Y, Aycart S, Mandeli JP et al. Extreme cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Outcomes from a single tertiary center. Surg Oncol 2015;24:264-9.
  • 22. Piso P, Nedelcut SD, Rau B et al. Morbidity and mortality following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Data from the DGAV StuDoQ Registry with 2149 consecutive patients. Ann Surg Oncol 2019;26:148-54.
  • 23. Kusamura S, Younan R, Baratti D, et al. Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion: analysis of morbidity and mortality in 209 peritoneal surface malignancies treated with closed abdomen technique. Cancer 2006;106:1144-53.
  • 24. Mehta SS, Gelli M, Agarwal D, Goéré D. Complications of cytoreductive surgery and HIPEC in the treatment of peritoneal metastases. Indian J Surg Oncol 2016;7:225-9.
  • 25. Deraco M, Baratti D, Kusamura S, Laterza B, Balestra MR. Surgical technique of parietal and visceral peritonectomy for peritoneal surface malignancies. J Surg Oncol 2009;100:321-8.
  • 26. Downs-Canner S, Ding Y, Magge DR, et al. A comparative analysis of postoperative pancreatic fistulas after surgery with and without hyperthermic intraperitoneal chemoperfusion. Ann Surg Oncol 2015;22:1651-7.
  • 27. Schwarz L, Votanopoulos K, Morris D, et al. Is the combination of distal pancreatectomy and cytoreductive surgery with HIPEC reasonable?: Results of an international multicenter study. Ann Surg 2016;263:369-75.
  • 28. Doud AN, Randle RW, Clark CJ, et al. Impact of distal pancreatectomy on outcomes of peritoneal surface disease treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol 2015;22:1645-50.
  • 29. Sullivan BJ, Leigh NL, Bekhor EY, et al. Distal pancreatectomy in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: Identifying risk and improving patient selection. Am J Surg 2020;220:1235-41.
Toplam 29 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Makaleler
Yazarlar

Yiğit Özgün Bu kişi benim 0000-0002-9278-4820

Volkan Öter Bu kişi benim 0000-0002-0639-1917

Erol Pişkin Bu kişi benim 0000-0002-6149-3000

Muhammet Çolakoğlu Bu kişi benim 0000-0002-6283-943X

Osman Aydın Bu kişi benim 0000-0001-8630-829X

Birol Bostancı Bu kişi benim 0000-0002-0663-0156

Yayımlanma Tarihi 26 Ağustos 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 20 Sayı: 2

Kaynak Göster

APA Özgün, Y., Öter, V., Pişkin, E., Çolakoğlu, M., vd. (2021). Effects of distal pancreatectomy and splenectomy on outcomes in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with CC/0 resection. Akademik Gastroenteroloji Dergisi, 20(2), 104-111. https://doi.org/10.17941/agd.978955

test-5