Extreme cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Outcomes from a single tertiary center

Assessing the impact of perioperative blood transfusions on the survival of adults undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for appendiceal carcinomatosis

“…In assessing factors influencing survival after CRS‐HIPEC, several authors have included PBTs as a study covariate. However, similar to the results of studies in other oncologic populations, PBTs have not always been an independent predictor of poorer survival in patients undergoing CRS‐HIPEC . The significance of PBTs as they relate to survival after CRS‐HIPEC is, therefore, not entirely clear.…”

Current perspectives on hyperthermic intraperitoneal chemotherapy in gastric cancer

“…36 The authors emphasized that careful patient selection is imperative, noting that only those who can achieve an R0/R1 status should be candidates for CRS-HIPEC. Selection criteria that have been shown to improve survival rates include fewer organ involvement/low tumor stage 23,33,36,37 ; World Health Organization Performance Status, 37 Table 3 shows the median survival rates of patients from selected trials by year. Interestingly, this table seems to demonstrate increasing CRS-HIPEC survival over time, a relationship that may be linked to improvements in patient selection.…”

“…Berger et al, 33 for example, showed that patients undergoing more extensive CRS-HIPEC (>5 organs resected or >3 bowel anastomoses) had significantly increased rates of intraoperative blood loss, surgery duration, hospital stay, and 30-day morbidity (34% vs 17.4%). This finding is similar to one by Magge et al, 37 which showed patients with >2 bowel anastomoses had poorer overall survival and disease progression.…”

“…32 At the same time, other studies have found that CRC-HIPEC has greatest efficacy when fewer organs are involved: extreme multivisceral resection was associated with higher major morbidity and inferior outcomes. 33 It is important to note that comparing the survival of those with extreme tumor burdens to those with lesser tumor burdens may be biased in its approach and produce deceptive data. Thus, visceral sparing seems to be important for overall survival and quality of life in the gastric cancer patient with peritoneal metastasis.…”

“…Importantly, no patients included in this study had local or systemic infections, wound disruption, or other clinically important adverse events. Some of the more common intraand postoperative complications that were studied included longer duration of surgery, 33 intraoperative blood loss, anastomotic leakage, surgical site infections and intra-abdominal abscesses, 64 re-operation, longer hospital stay, respiratory complications, and chemotherapy or HIPEC-related toxicity. Overall, many of these studies either support CRS-HIPEC for reducing morbidity or find that the morbidity associated with CRS-HIPEC is acceptable given the associated increase in life expectancy.…”