Detours on the Road to Recovery: What Factors Delay Readiness to Return to Intended Oncologic Therapy (RIOT) After Liver Resection for Malignancy?

Lillemoe, Heather A.; Marcus, Rebecca; Kim, Bradford J.; Narula, Nisha; Davis, Catherine H.; Aloia, Thomas A.

doi:10.1007/s11605-019-04165-5

Cited by 16 publications

(6 citation statements)

References 32 publications

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“…The few studies that have been published show achieving RIOT is influenced by patient comorbidities, intraoperative techniques, and postoperative complications. 33,35 Further, an inability to achieve RIOT is independently associated with decreased recurrence-free survival and overall survival. An assessment and understanding of the impact that modifiable patient and surgical factors and outcomes may have on time to adjuvant treatment is critical.…”

Section: Discussionmentioning

confidence: 99%

“…The return to intended oncologic therapy (RIOT) is a newly developed and validated oncologic metric that directly reflects the period between surgery and appropriate recuperation for initiation of adjuvant treatments. [33][34][35] With a variety of radiologic and surgical techniques available for adequate oncologic resections, including induction of FLR growth, evaluation of RIOT between techniques is important and has yet to be evaluated. As such, we aimed to retrospectively assess whether there was a difference in RIOT with and between liver molding techniques in patients undergoing trisectionectomy.…”

Section: Introductionmentioning

confidence: 99%

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Faster Return to Intended Oncologic Treatment (RIOT) After Trisectionectomy Does Not Translate to Better Outcomes

Baimas-George

Watson

Pickens

et al. 2020

The American Surgeon

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Background Resection with trisectionectomy may necessitate liver molding for adequate future liver remnant (FLR), and subsequent complications can impact return to intended oncologic therapy (RIOT). This study evaluated whether a difference in RIOT exists with the use of molding and between liver molding techniques (associating liver partition and portal vein ligation for staged hepatectomy [ALPPS] and portal vein embolization [PVE]) with trisectionectomy. Methods A retrospective review evaluated trisectionectomies for malignancy. Outcomes were compared with and without molding, and RIOT was determined. Results Fifty-one patients underwent trisectionectomy: 11 ALPPS, 14 PVE, 26 without molding. 73% of ALPPS, 64% of PVE, and 58% without molding achieved RIOT ( P = .971). There were no differences found in baseline characteristics, R0 rate, length of stay, readmission, complications, or mortality. Time to RIOT was significantly different (ALPPS: 3.3 months; PVE: 5.2 months; none: 2.4 months, P = .0203). There were no differences in recurrence or survival. Conclusions Liver molding should not cause apprehension as there are no differences in achieving RIOT. Although technique alters time to RIOT, this does not translate into improved outcomes, implicating disease biology, and regeneration stimulus.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Faster Return to Intended Oncologic Treatment (RIOT) After Trisectionectomy Does Not Translate to Better Outcomes

Baimas-George

Watson

Pickens

et al. 2020

The American Surgeon

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“…The concept of return to intended oncologic treatment (RIOT) was recently proposed [ 45 ], as a novel quality metric for oncological anaesthesia and surgery. Both anaesthetic and surgical strategies, developed in order to reduce potentially avoidable postoperative complications, to enhance recovery and to improve RIOT in oncologic patients with different types of solid tumours, were investigated and proposed [ 46 , 47 , 48 ].…”

Section: Hyperoxia Effects On Surgical Cancer Patients—clinical and Experimental Datamentioning

confidence: 99%

Exploring Hyperoxia Effects in Cancer—From Perioperative Clinical Data to Potential Molecular Mechanisms

Ristescu

Tiron

et al. 2021

Biomedicines

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Increased inspiratory oxygen concentration is constantly used during the perioperative period of cancer patients to prevent the potential development of hypoxemia and to provide an adequate oxygen transport to the organs, tissues and cells. Although the primary tumours are surgically removed, the effects of perioperative hyperoxia exposure on distal micro-metastases and on circulating cancer cells can potentially play a role in cancer progression or recurrence. In clinical trials, hyperoxia seems to increase the rate of postoperative complications and, by delaying postoperative recovery, it can alter the return to intended oncological treatment. The effects of supplemental oxygen on the long-term mortality of surgical cancer patients offer, at this point, conflicting results. In experimental studies, hyperoxia effects on cancer biology were explored following multiple pathways. In cancer cell cultures and animal models, hyperoxia increases the production of reactive oxygen species (ROS) and increases the oxidative stress. These can be followed by the induction of the expression of Brain-derived neurotrophic factor (BDNF) and other molecules involved in angiogenesis and by the promotion of various degrees of epithelial mesenchymal transition (EMT).

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“…Publication of results from these trials will inform an audience increasingly seeking strategies to enable patients to recover faster and initiate adjuvant oncologic therapy sooner (114). Newer reports have begun to focus on this outcome as more minimally invasive approaches have been found to be associated with faster return to oncologic therapy in other cancer processes (115,116).…”

Section: Minimally Invasive Gastrectomymentioning

confidence: 99%

Advances in the surgical management of gastric and gastroesophageal junction cancer

Narayan¹,

Poultsides²

2021

Transl Gastroenterol Hepatol

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Since Theodore Billroth and Cesar Roux perfected the methods of post-gastrectomy reconstruction in the late 19 th century, surgical management of gastric and gastroesophageal cancer has made incremental progress. The majority of patients with localized disease are treated with perioperative combination chemotherapy or neoadjuvant chemoradiation. Staging laparoscopy before initiation of treatment or before surgical resection has improved staging accuracy and can drastically inform treatment decisions. The longstanding and contentious debate on the optimal extent of lymph node dissection for gastric cancer appears to have settled in favor of D2 dissection with the recently published 15-year followup of the Dutch randomized trial. Minimally invasive gastric and gastroesophageal resections are performed routinely in most centers affording faster recovery and equivalent oncologic outcomes. Pylorus-preserving distal (central) gastrectomy has emerged as a less invasive, function-preserving option for T1N0 middlethird gastric cancers, while randomized data on its oncologic adequacy are pending. Multi-visceral resections and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy has been utilized selectively for patients with locally advanced tumors who have demonstrated disease control on preoperative chemotherapy.This review summarizes the current standard of surgical care for gastroesophageal junction and gastric cancer as well as highlights recent and upcoming advances to the field.

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Detours on the Road to Recovery: What Factors Delay Readiness to Return to Intended Oncologic Therapy (RIOT) After Liver Resection for Malignancy?

Cited by 16 publications

References 32 publications

Faster Return to Intended Oncologic Treatment (RIOT) After Trisectionectomy Does Not Translate to Better Outcomes

Faster Return to Intended Oncologic Treatment (RIOT) After Trisectionectomy Does Not Translate to Better Outcomes

Exploring Hyperoxia Effects in Cancer—From Perioperative Clinical Data to Potential Molecular Mechanisms

Advances in the surgical management of gastric and gastroesophageal junction cancer

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