The cost of cytoreductive surgery and perioperative intraperitoneal chemotherapy in the treatment of peritoneal malignancy in one Greek institute.

PURPOSE: Cytoreductive surgery and perioperative intraperitoneal chemotherapy in the treatment of patients with peritoneal malignancy is expensive. The purpose of this study was to estimate the current cost of cytoreductive surgery combined with perioperative intraperitoneal chemotherapy and identify the most significant related parameters in one center in Greece. METHODS: A retrospective economic study was carried out on 105 patients that underwent 108 cytoreductive operations and hyperthermic intraoperative peritoneal chemotherapy (HIPEC) from 2006-2011 for peritoneal malignancy. The economic cost included the daily cost of hospital bed occupancy, the daily cost of occupancy in the intensive care unit (ICU), the expenditures (materials and drugs), and the preoperative, intraoperative, and postoperative examinations. RESULTS: The mean length of stay in the ICU and the mean hospitalization time was 5 and 23 days, respectively. The hospital mortality and morbidity was 5.6% (6 patients) and 48.17percnt; respectively. The mean cost of treatment was 15677.3±11910.6 euros (range=4258,47-95990,87) per patient. Morbidity (p=0.009), and prolonged stay in the ICU (p<0.001) were the parameters that influenced independently the cost of treatment. CONCLUSION: Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy is an expensive treatment. The economic cost is largely influenced by morbidity and the length of stay in the ICU.

Adjuvant perioperative intraperitoneal chemotherapy in locally advanced colorectal carcinoma: preliminary results.

Background and Aims. Intraperitoneal chemotherapy is a basic tool in the treatment of peritoneal malignancy. The purpose of the study is to investigate the effect of adjuvant perioperative intraperitoneal chemotherapy in the treatment of locally advanced colorectal cancer. Patients and Methods. Patients with T(3) and T(4) colorectal carcinomas that underwent R(0) resection received either hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC group = 40 patients) or early postoperative intraperitoneal chemotherapy (EPIC group = 67 patients). The survival, the recurrences and the sites of recurrence were assessed. Results. The 3-year survival rate for HIPEC group was 100% and for EPIC group 69% (P = .011). Nodal infiltration was found to be the single prognostic indicator of survival. The incidence of recurrence in EPIC group was higher than in HIPEC group (P = .009). The independent indicators of recurrence were the use of HIPEC and the degree of differentiation (P < .05). Conclusions. Intraperitoneal chemotherapy, particularly HIPEC, as an adjuvant in locally advanced colorectal carcinomas appears to improve survival and decrease the incidence of recurrence.

Long-term results following potentially curative gastrectomy for gastric cancer.

PURPOSE: The purpose of this study was to report the results of gastric cancer surgery in patients who had undergone potentially curative gastrectomy. METHODS: The hospital mortality, morbidity, survival, recurrences and the sites of failure were retrospectively analyzed in D1 group (conventional gastrectomy), and in D2 group (extended lymph node resection). RESULTS: D1 and D2 groups were comparable for age, gender, American Society of Anesthesiologists (ASA) class, type of surgery, and histopathologic characteristics (p>0.05). D2 group patients were in better physical status (p=0.008). The recurrence rate was higher in D1 group (p=0.019). Independent prognostic indicators of morbidity were male gender (p=0.012), and poor ASA class (p<0.001). Poor ASA class was the single independent prognostic indicator of hospital mortality (p=0.001). Ten-year survival for D1 and D2 was 44.1 and 64.8%, respectively (p=0.0433). D2 gastrectomy improved survival in stage IIIA. The independent prognostic indicators of survival were total gastrectomy (p=0.003), lymph node involvement (p<0.0001), and extended lymphadenectomy (p=0.003). The independent prognostic variables of recurrence were stage (p=0.001), and extended lymph node resection (p=0.006). CONCLUSION: D2 gastrectomy improves survival in gastric cancer, particularly in stage IIIA.

Differences between right- and left-sided colon carcinomas.

PURPOSE: Clinical, histopathological, and biological differences between right and left colon carcinomas have been questioned in the literature. The purpose of this retrospective study was to identify possible clinical and histopathological differences between the right and left colon carcinomas. METHODS: From 1987-2007, 109 patients with right colon carcinomas (RC group), and 186 patients with left colon carcinomas (LC group) were treated at a single institution. Clinical, histopathological, and biological variables were correlated to tumor location. The endpoint of the study was to see for any relationship between overall survival, recurrences, and their pattern in regard to tumor location. RESULTS: The incidence of distant metastases at initial diagnosis (p=0.049), and poorly differentiated tumors (p=0.001) was higher in right colon carcinomas. The 10-year survival rate in the RC group was 63% and in the LC group 66% (p >0.05). Recurrences, sites of recurrence, the in-hospital mortality and morbidity were similar in both groups (p >0.05). CONCLUSION: The biological behavior of right and left colon carcinomas is similar despite minor histopathological differences that do not influence survival and development of recurrences.

The impact of total mesorectal excision in middle and low rectal carcinomas.

PURPOSE: The incidence of locoregional recurrence in rectal cancer has declined since total mesorectal excision (TME) has been widely adopted. The purpose of this study was to investigate the long-term survival and the incidence of locoregional recurrences in patients with middle and low rectal carcinomas undergoing TME. METHODS: The medical records of 126 patients with middle and low rectal carcinomas treated from 1987-2007 were retrospectively reviewed. Of them 80 had undergone total mesorectal excision (TME-group) and 46 surgery with conventional methods (CON-group). Clinical variables were correlated to morbidity, hospital mortality, recurrence, sites of recurrence, and survival. RESULTS: The groups were comparable except for type of surgery and sites of recurrence. Five-year overall survival rate for TME group was 75% and for CON-group 47% (p=0.0346). Although the groups were not different for the total number of recurrences, the number of locoregional recurrences was significantly lower in TME group (p=0.004). CONCLUSION: TME appears to improve long-term survival in patients with middle and low rectal carcinomas. The incidence of locoregional recurrence is also reduced by TME.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal carcinomatosis. Preliminary results and cost from two centers in Greece.

PURPOSE: To report our preliminary experience in the combined treatment of peritoneal carcinomatosis (PC) using cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC). PATIENTS AND METHODS: This prospective study included patients with PC from gynaecological, gastric and colon cancer, treated in two centers. Cytoreductive surgery included the peritonectomy procedures described by Jacquet and Sugarbaker as well as multivisceral resections in order to achieve a complete macroscopical cancer eradication. The HIPEC that followed was performed via the open abdomen technique. RESULTS: Twenty-four patients (3 men and 21 women, mean age 60 years) were treated. Twelve patients had PC from ovarian cancer, 7 from colon, 3 from gastric and 2 from uterine cancer. The mean duration of the procedure was 7.83 h (range 5 -12.30). Macroscopically, complete cytoreduction (CC) was achieved in 18 (75%) patients. Two (8.3%) patients died in the first 30 days. The overall morbidity was 42% and 2 patients were reoperated. The mean follow up was 22 months (range 3-36). The overall 1-year survival was 59.1%; concerning the gynaecological cancers it was 53.8% (mean survival 11.7 months) and for gastrointestinal cancers it was 44.4% (mean survival 9.5 months). CONCLUSION: Our preliminary data suggest that the combined treatment of cytoreduction plus HIPEC for PC is associated with acceptable mortality and morbidity and offers an improved survival in these patients. An optimal patient selection and establishment of experienced centres are of paramount importance.

Oophorectomy during surgery for colorectal carcinoma.

BACKGROUND: The purpose of the study is to identify the effect of synchronous prophylactic oophorectomy in women undergoing colorectal cancer surgery on long-term survival, recurrences and sites of failure. PATIENTS AND METHODS: From 1987 to 2003, 124 women, mean age 69+/-10 (35-91) years, with colorectal carcinoma were retrospectively reviewed. In 70 (56.5%) women the ovaries were preserved during surgery and 54 (43.5%) women underwent synchronous prophylactic oophorectomy during primary tumour resection. Univariate and multivariate analysis were used to assess the effect of oophorectomy on long-term survival, recurrences and sites of failure. RESULTS: By univariate analysis it was demonstrated that synchronous oophorectomy had no effect on long-term survival (p=0.7294). By multivariate analysis it was demonstrated that stage was the only factor independently influencing survival (p=0.0061). Twenty-eight patients (23%) developed recurrence and 10 of them developed locoregional recurrence. By univariate analysis it was demonstrated that the number of recurrences was not different between women with or without oophorectomy (p=0.259). Distant and locoregional recurrences were not different between women undergoing resection of primary colorectal carcinoma with or without oophorectomy (p=0.611). CONCLUSIONS: Oophorectomy does not appear to influence long-term survival, the total number of recurrences or the sites of failure.