1. Enhanced postoperative recovery with minimally invasive cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal surface malignancies of gastrointestinal origin.
- Author
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Koti S, Conte C, Kadison AB, Sullivan JS, Wang J, Zaidi R, and Deutsch GB
- Subjects
- Adult, Aged, Body Mass Index, Carcinoma secondary, Female, Humans, Laparoscopy, Length of Stay statistics & numerical data, Male, Middle Aged, Peritoneal Neoplasms secondary, Recovery of Function, Carcinoma therapy, Cytoreduction Surgical Procedures methods, Gastrointestinal Neoplasms pathology, Hyperthermic Intraperitoneal Chemotherapy methods, Peritoneal Neoplasms therapy, Postoperative Complications epidemiology, Robotic Surgical Procedures methods
- Abstract
Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are the treatment of choice for select patients with peritoneal surface malignancies; however, the traditional open approach may be associated with significant morbidity. We evaluated postoperative outcomes with minimally invasive (MI) CRS and HIPEC., Methods: Review of our institutional database identified 47 patients who underwent optimal cytoreduction (CC0 or CC1). Those with a PCI ≤ 15 and primary malignancy of gastrointestinal origin were then selected for subgroup analysis. Multivariable regression was performed to identify factors impacting postoperative outcomes., Results: Demographic data did not significantly differ between open (n = 24) and minimally invasive (n = 9) groups. The MI group had a mean age of 57.34 ± 14.92, BMI of 27.03 ± 4.27, Charlson comorbidity score of 1.78 ± 1.72, and PCI of 5.56 ± 5.08. Mean time to flatus (days) was 2.78 in the MI group and 5.04 in the open group (p < 0.001), and mean length of IV analgesic use (days) was 3.11 in the MI group compared to 6.00 in the open group (p = 0.006). Mean length of stay (days) was 5.11 in the MI group and 8.67 in the open group (p = 0.033). Surgical approach (p = 0.037) and BMI (p = 0.039) were the only factors impacting length of stay., Conclusions: Minimally invasive CRS and HIPEC is an excellent option for low volume peritoneal disease of gastrointestinal origin. A minimally invasive approach yields faster return of bowel function, reduced postoperative analgesia requirements, and shorter hospital stay., Competing Interests: Declaration of competing interest The authors have no commercial interest in the subject of study., (Copyright © 2019 Elsevier Ltd. All rights reserved.)
- Published
- 2020
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