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Annals of Surgical Oncology

, Volume 26, Issue 5, pp 1445–1453 | Cite as

Repeat Cytoreductive Surgery-Hyperthermic Intraperitoneal Chemoperfusion is Feasible and Offers Survival Benefit in Select Patients with Peritoneal Metastases

  • Haroon A. ChoudryEmail author
  • Filip Bednar
  • Yongli Shuai
  • Heather L. Jones
  • Reetesh K. Pai
  • James F. Pingpank
  • Steven S. Ahrendt
  • Matthew P. Holtzman
  • Herbert J. Zeh
  • David L. Bartlett
Peritoneal Surface Malignancy
  • 111 Downloads

Abstract

Introduction

We hypothesized that repeat cytoreductive surgery-hyperthermic intraperitoneal chemoperfusion (CRS-HIPEC) for peritoneal metastases (PM) may be associated with suboptimal resection, more frequent postoperative complications, and worse oncologic outcomes.

Methods

Using a prospectively maintained database, we compared clinicopathologic, perioperative, and oncologic outcome data in patients undergoing single or repeat CRS-HIPEC procedures. The Kaplan–Meier method was used to estimate survival. Multivariate analyses identified associations with perioperative and oncologic outcomes.

Results

Of the 1294 patients undergoing CRS-HIPEC procedures at our institution, only one CRS-HIPEC procedure (single HIPEC cohort) was performed in 1169 patients (90.3%), whereas 125 patients (9.7%) underwent repeat CRS-HIPEC procedures (repeat HIPEC cohort). Of the 1440 CRS-HIPEC procedures at our institution, a first CRS-HIPEC procedure was performed in 1294 patients (89.9%), whereas subsequent second, third, and fourth CRS-HIPEC procedures were performed in 125 patients (8.7%), 18 patients (1.3%), and 3 patients (0.2%), respectively. Progression-free survival (PFS) following the second CRS-HIPEC procedure was negatively impacted by shorter PFS following the first CRS-HIPEC procedure, independent of other significant variables related to the second procedure, including completeness of cytoreduction and postoperative complications. Patients undergoing multiple CRS-HIPEC procedures were not at higher risk for suboptimal resection or postoperative complications and demonstrated equivalent PFS following each successive procedure compared to the first procedure.

Conclusions

Repeat CRS-HIPEC procedures for PM were not associated with suboptimal perioperative and oncologic outcomes. Our data confirmed our ability to select patients appropriately for repeat CRS-HIPEC procedures.

Notes

Acknowledgment

This work was partially funded by generous support from Valarie Koch and the New Era Cap Company. The project was supported by the National Institutes of Health through Grant Number UL1-TR-001857, using a Red cap maintained database.

Disclosures

None.

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Haroon A. Choudry
    • 1
    Email author
  • Filip Bednar
    • 1
  • Yongli Shuai
    • 3
  • Heather L. Jones
    • 1
  • Reetesh K. Pai
    • 2
  • James F. Pingpank
    • 1
  • Steven S. Ahrendt
    • 1
  • Matthew P. Holtzman
    • 1
  • Herbert J. Zeh
    • 1
  • David L. Bartlett
    • 1
  1. 1.Division of Surgical OncologyKoch Regional Perfusion Center, University of PittsburghPittsburghUSA
  2. 2.Department of PathologyUniversity of PittsburghPittsburghUSA
  3. 3.The University of Pittsburgh Cancer Institute Biostatistics FacilityPittsburghUSA

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