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Genitourinary Resection at the Time of Cytoreductive Surgery and Heated Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis Is Not Associated with Increased Morbidity or Worsened Oncologic Outcomes: A Case-matched Study

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Cytoreductive surgery (CRS) with heated intraperitoneal chemotherapy (HIPEC) has gained acceptance in the treatment of peritoneal carcinomatosis with reported morbidity and mortality rates of 27–56 and 0–11 %, respectively. The safety and oncologic outcome of genitourinary repair at the time of CRS and HIPEC remains unclear.

Methods

We identified 170 patients who underwent CRS-HIPEC at our institution between July 2007 and August 2011 with a minimum follow-up of 6 months. Thirty-four (20 %) underwent concomitant urologic reconstruction at the time of CRS-HIPEC and were matched by disease burden (intraoperative peritoneal cancer index [PCI]) and extent of surgery (ΔPCI) with a cohort of 38 (22.3 %) subjects without genitourinary involvement. The primary end points considered for this analysis included the development of major surgical (Clavien–Dindo Class III–V) complications and overall survival.

Results

Median follow-up was 9.4 months. The most commonly performed urologic interventions included partial cystectomy with primary repair in 23 (65.7 %) and segmental ureteral resection and repair in 11 (31.4 %). Patients with genitourinary reconstruction had more total organ involvement (6.5 vs. 4.3, p < 0.001) and more commonly underwent enteric anastomoses (82.4 vs. 57.9 %, p = 0.025). No significant differences were observed with regard to major morbidity, need for transfusion, operative time, intensive care unit admission, or length of stay. Among patients with appendiceal or colonic tumors (n = 46), overall survival was similar between genitourinary reconstruction and matched cohorts: 22.5 versus 15.1 months, respectively (p = 0.66).

Conclusions

Genitourinary reconstruction at the time of CRS-HIPEC occurs more commonly in patients with extensive disease burden undergoing radical debulking, yet does not adversely influence surgical morbidity or survival.

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Authors and Affiliations

  1. Department of Urology, Mount Sinai School of Medicine, New York, NY, USA

    Michael S. Leapman MD, Simon J. Hall MD & Michael Palese MD

  2. Department of Surgical Oncology, Mount Sinai School of Medicine, New York, NY, USA

    Parissa Tabrizian MD, Bernardo Franssen MD, Ming-Jim Yang MD, Anya Romanoff MD, Umut Sarpel MD, Spiros Hiotis MD, PhD & Daniel Labow MD

  3. Department of Urology, Brookdale University Hospital and Medical Center, New York, NY, USA

    Ghalib Jibara MD, MPH

Authors
  1. Michael S. Leapman MD
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  2. Ghalib Jibara MD, MPH
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  3. Parissa Tabrizian MD
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  4. Bernardo Franssen MD
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  5. Ming-Jim Yang MD
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  6. Anya Romanoff MD
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  7. Simon J. Hall MD
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  8. Michael Palese MD
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  9. Umut Sarpel MD
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  10. Spiros Hiotis MD, PhD
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  11. Daniel Labow MD
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Correspondence to Parissa Tabrizian MD.

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Leapman, M.S., Jibara, G., Tabrizian, P. et al. Genitourinary Resection at the Time of Cytoreductive Surgery and Heated Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis Is Not Associated with Increased Morbidity or Worsened Oncologic Outcomes: A Case-matched Study. Ann Surg Oncol 21, 1153–1158 (2014). https://doi.org/10.1245/s10434-013-3393-8

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  • DOI: https://doi.org/10.1245/s10434-013-3393-8

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