Outcomes following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal malignancies: 10 ​Year experience.

INTRODUCTION: The treatment of peritoneal malignancies has evolved and select patients can undergo effective surgical therapies. Access to innovative oncology procedures can be improved if programs are developed within and outside of academic cancer centers. We report the creation of a high volume, comprehensive peritoneal malignancy program developed in a community center. METHODS: A retrospective single-site study was conducted using registry data comprising all patients who underwent Cytoreductive Surgery (CRS) and Heated Intraperitoneal Chemotherapy (HIPEC) between October 2011-December 2021. RESULTS: 353 patients underwent CRS and HIPEC. 208 patients experienced in-hospital morbidity (58.9 â€‹%). Group comparison by disease site, PCI, and the completeness of cytoreduction demonstrated survival differences in mean overall survival and disease-free survival in 1-, 3- and 5-year ranges. CONCLUSIONS: This study demonstrates that with a standardized protocol and a surgeon-led multidisciplinary team it is possible to offer safe outcome driven, complex oncologic surgery in a community-based cancer program.

Life after hyperthermic intraperitoneal chemotherapy; measuring quality of life and performance status after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy.

BACKGROUND: Patients who undergo cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) can return to an acceptable performance status (PS) and quality of life 3 months postoperative. METHODS: An HIPEC specific questionnaire was developed based on the validated Functional Assessment of Cancer Therapy Questionnaire. Each patient was contacted and questionnaire completed. An averaged score was calculated and stratified to an Eastern Cooperative Oncology Group PS. A retrospective chart review gathered patient characteristics and correlated to the patient's 3 months postoperative PS. RESULTS: Between October 2011 and July 2014, 43 patients underwent complete CRS with HIPEC. The most common indications for surgery were colorectal (35%) and appendiceal malignancy (47%). Average scores were: physical well-being 15.4 of 20, social well-being 17.5 of 20, recovery 15 of 20, mental well-being 13.4 of 20, and functional well-being 18.1 of 24. These correlated to an Eastern Cooperative Oncology Group PS of 1, 0, 1, 1, and 1. Patient's age (P = .235), operative length (P = .181), hospital duration (P = .43), complications or peritoneal carcinomatosis index (P = .815) demonstrated no significance relative to postoperative PS. CONCLUSIONS: Patients can recovery well from CRS with HIPEC. It is possible to return to an acceptable functional status within 3 months postoperative. Age, operative time, length of hospital stay, or peritoneal carcinomatosis index have no prohibitive effects on a long-term recovery.

Establishing a complex surgical oncology program with low morbidity and mortality at a community hospital.

BACKGROUND: We report our experience with a large volume of complex oncologic resections and describe the framework necessary to develop a program with low morbidity and mortality in a community hospital. METHODS: From August 2010 to May 2014, 224 consecutive patients underwent abdominal oncological resection, at a community hospital by a single surgeon (R.N.B.). Cases included pancreatic, gastric, hepatobiliary, colorectal, hyperthermic intraperitoneal chemotherapy with cytoreduction, splenic, and sarcoma resections. We retrospectively reviewed our prospectively maintained database and evaluated postoperative complications. RESULTS: There was no 0, 30-, 60-, or 90-day mortality. The complication rate was 44%, including 5% grade I, 28% grade II, 9% grade III, and 1% grade IV complications. The median length of stay was 8 days. Mean follow-up for the entire group was 643 days. CONCLUSION: Our study demonstrates that complex oncologic resections can be safely performed in the community setting if a well-organized, surgeon-led multidisciplinary team is assembled.