Preoperative nutritional risk assessment in patients undergoing cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for colorectal carcinomatosis

Banaste, Nathan; Rousset, Pascal; Mercier, Frédéric; Rieussec, Clémentine; Valette, Pierre-Jean; Gléhen, Olivier; Passot, Guillaume

doi:10.1080/02656736.2017.1371342

Cited by 24 publications

(38 citation statements)

References 24 publications

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“…PCI has been one of the most consistent independent predictors of morbidity and mortality from CRS-HIPEC. 2,[5][6][7][8][9] There has, however, been no consensus on a PCI cut off in CPM that predicts poorer post-operative outcomes, with studies thus far reporting a wide range (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) that are significantly predictive of DFS and OS. 6,8,[10][11][12] Results from our study suggest that for patients with PC from colorectal primaries, a lower cut-off value of 7-11 is a satisfactorily significant predictor of postoperative OS.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of previous studies on this topic have reported on the predictive value of DFI between repeated CRS-HIPEC for higher PCI, CC score and poorer long-term survival. 9,10,13,14 Our study is one of the few to define DFI as the interval between index curative surgery and first metachronous peritoneal recurrence for which the patient underwent CRS-HIPEC. A longer DFI is a surrogate marker of favourable tumour biology, and allows optimization of nutritional and functional status preoperatively, a factor reported to be significantly associated with post-CRS-HIPEC OS.…”

Section: Discussionmentioning

confidence: 99%

“…A longer DFI is a surrogate marker of favourable tumour biology, and allows optimization of nutritional and functional status preoperatively, a factor reported to be significantly associated with post-CRS-HIPEC OS. 14 Nagata et al is one of the only studies with analysis performed specifically on the DFI between CRC and subsequent metachronous CPM. They found DFI <12 months as a significant predictor of OS after diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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Novel prognostic score for outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal cancer with metachronous peritoneal carcinomatosis

Chin

Tan

Chia

et al. 2020

ANZ Journal of Surgery

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Background: This study aimed to determine pre-and peri-operative parameters with significant predictive value for post-operative outcomes in patients with recurrent colorectal cancer presenting as peritoneal carcinomatosis undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC), and to develop a novel prognostic scoring system for prediction of survival outcomes. Methods: A single-institution review of prospectively collected data from all patients who underwent CRS-HIPEC between October 2005 and October 2017 was conducted. Univariate and multivariate analyses were used to identify significant parameters for prediction of post-CRS-HIPEC disease-free survival and overall survival (OS). Results: A total of 278 patients underwent CRS-HIPEC, of whom 72 were for peritoneal carcinomatosis from recurrent colorectal cancer. Disease-free interval (DFI; P = 0.006), peritoneal cancer index (PCI; P = 0.001) and left upper quadrant disease (P = 0.023) were significant independent predictors of 3-year OS. DFI (0.007), PCI (P < 0.001) and intraoperative blood loss (BL; P = 0.001) were significant independent predictors of 5-year OS. PCI and BL were significant independent predictors of both 3-year (P = 0.026, PCI; P = 0.009, BL) and 5-year (P = 0.002, PCI; P = 0.011, BL) disease-free survival. Predictive models were developed for risk stratification of OS. Conclusion: PCI, DFI, left upper quadrant disease and BL have significant predictive value for post-CRS-HIPEC outcomes. Risk stratification models allow for more prudent patient selection and ultimately more accurate prognostication of post-operative outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Novel prognostic score for outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal cancer with metachronous peritoneal carcinomatosis

Chin

Tan

Chia

et al. 2020

ANZ Journal of Surgery

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“…Optimization of enteral nutrition should be considered in all patients before surgery particularly those who are malnourished (albumin <30) to reduce morbidity and mortality [17].…”

Section: Preoperative Preparationmentioning

confidence: 99%

An update of peritonectomy procedures used in cytoreductive surgery for peritoneal malignancy

Mercier

Mohamed

Cazauran

et al. 2019

International Journal of Hyperthermia

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Background: Complete cytoreduction is acknowledged to be an effective way to achieve macroscopic tumor clearance for a variety of tumors confined to the peritoneal cavity. Recent trials have shown that surgery respecting anatomical planes results in excellent outcomes and even the chance of cure for some from what was once thought to be life-limiting disease. Objective: To describe peritonectomy procedures in the current era. Method: A thorough and systematic method for cytoreductive surgery aimed at complete surgical resection of peritoneal metastases (PMs) was described. Results: The general principles of cytoreductive surgery were set out including preoperative preparation, patient positioning and incision. Strategies for assessing disease extent and planning surgical steps were outlined and established peritonectomy procedures such as Glisson's capsulectomy, omentectomy, left and right diaphragmatic peritonectomy, lesser omentectomy, stripping of the omental bursa, and pelvic peritonectomy were described. Novel techniques such as anterior pancreatic peritonectomy, small bowel mesenteric peritonectomy and cardiophrenic lymph node dissection were explained, and illustrated with accompanying video. Conclusion: Peritoneal metastases present a challenge to the surgeon which calls for a unique skill set if optimal outcomes are to be achieved. Attempts to standardize the surgical techniques described will allow further refinement as new technological advances occur. ARTICLE HISTORY

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“…Verwaal et al [4] demonstrated in a randomised trial that CRS and HIPEC offers an improved survival of 22.3 months compared to 12.6 months with systemic chemotherapy only in the management of colorectal peritoneal metastases. Since then, a number of other studies have reported favourable median survival of 30-58 months with CRS and HIPEC, with a 27-46% 5-year survival [5][6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Perceptions in the management of colorectal peritoneal metastases: A bi-national survey of colorectal surgeons

Narasimhan

Warrier

Michael

et al. 2019

Pleura and Peritoneum

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BackgroundThere is great variability in the uptake of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in the management of colorectal peritoneal metastases (CRPM) in Australia and New Zealand. This study aims to provide a snapshot of perceptions among colorectal surgeons in the management of CRPM.MethodsA structured ten-question online survey was sent to all colorectal surgeons, with three questions on clinical experience and demographics, one on health economics and six on hypothetical clinical scenarios. Scores were collated and reported based on Likert scales.ResultsEighty-one respondents (36.2%) completed the survey. Most surgeons (66.7%) strongly disagreed with offering CRS and HIPEC at all hospitals. The majority (87.7%) agreed that CRS and HIPEC offered a higher survival benefit than systemic chemotherapy in pseudomyxoma peritonei (PMP), and 69.1% in CRPM (comparators: 60.5% ovarian cancer, 14.8% gastric cancer). There were mixed strategies in managing low-volume, isolated peritoneal recurrences. The majority did not recommend second-look laparoscopy, but favoured operative management of Krukenberg tumours. In the presence of incidental peritoneal metastases, only 29.6% favoured biopsy only and referring the patient to a peritoneal disease centre.ConclusionsResponse rate was relatively low. In Australia and New Zealand, colorectal surgeons see a strong role for CRS and HIPEC in the management of PMP and CRPM. The role of “second look” surgery in high-risk cases is controversial and not supported. Krukenberg tumours are viewed as surgical disease. Regular updates and collaboration with peritoneal centres may help surgeons stay abreast with latest evidence in the field.

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Preoperative nutritional risk assessment in patients undergoing cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for colorectal carcinomatosis

Abstract: Hypoalbuminemia appears as a strong predictive factor for decreased overall survival in patients presenting PM of colorectal origin undergoing CRS-HIPEC.

Cited by 24 publications

References 24 publications

Novel prognostic score for outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal cancer with metachronous peritoneal carcinomatosis

Novel prognostic score for outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal cancer with metachronous peritoneal carcinomatosis

An update of peritonectomy procedures used in cytoreductive surgery for peritoneal malignancy

Perceptions in the management of colorectal peritoneal metastases: A bi-national survey of colorectal surgeons

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