Comparison of the outcomes of cytoreductive surgery versus surgery plus hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis: a propensity score matching analysis.

BACKGROUND: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are effective treatment options for selected patients with peritoneal carcinomatosis (PC). We compared the short-term outcomes of surgery plus HIPEC and CRS alone for PC. METHODS: We retrospectively examined patients who underwent CRS-HIPEC for PC at a single center from 2014 to 2019 using the Chinese CRS-HIPEC patient database at our institution. Patients were divided into two groups: surgery plus HIPEC (450) and surgery alone (200). A 1:1 propensity score matching (PSM) analysis was performed. The postoperative outcomes, mortality, and length of hospital stay were compared between the surgery plus HIPEC and CRS alone groups. RESULTS: Propensity scoring generated 162 pairs. There was no statistically significant difference in the 30-day mortality rate between the groups (0% vs 0%, P = 1.000), and the morbidity rates were similar in both groups (7.4% vs 8.0%, P = 0.835). The surgery plus HIPEC group had a longer operative time (247.81 ± 64.70 vs 184.55 ± 29.56, P ≤ 0.001) and a slightly longer postoperative hospital stay (14.64 ± 5.24 vs 12.59 ± 3.76, P ≤ 0.001). No other baseline characteristics were significantly different. CONCLUSIONS: Surgery plus HIPEC is feasible for select patients and is associated with prolonged surgery times and prolonged hospital stays, and there is no significant difference in mortality rates or postoperative outcomes.

Retrospective study of laparoscopic versus open gastric resection for gastric gastrointestinal stromal tumors based on the propensity score matching method.

BACKGROUND: Surgical resection with a free margin is considered the gold standard for the treatment of gastric gastrointestinal stromal tumors (GISTs). Previous studies about the advantages of laparoscopic resection versus open surgery have generally been non-randomized and retrospective and have some obvious shortcomings that could influence the veracity and reliability of the results. Therefore, the aim of this study was to evaluate the efficacy of laparoscopic resection in the treatment of gastric GISTs using the propensity score matching (PSM) method. METHODS: Between 2005 and 2014, 217 consecutive patients undergoing laparoscopic or open resection for gastric GISTs were enrolled in a retrospective, single-center study. Patient and tumor characteristics, intraoperative and postoperative characteristics, and oncologic outcomes were collected from a database. The efficacy of the laparoscopic approach was analyzed using the PSM method by comparing the clinical parameters of patients who underwent laparoscopic (LAP) and open resection (OPEN) procedures. RESULTS: After PSM, 88 patients involved in the analysis (44 LAP vs. 44 OPEN) were randomly matched (1:1) by tumor size, localization, disease course, body mass index, age, and gender. The LAP group was clearly superior to the open group in terms of intraoperative indicators and postoperative short-term efficacy. The incidence of postoperative complications in the LAP group was lower than in the OPEN group (4.5 vs. 18.2 %, P = 0.044). A survival analysis showed that there was no significant difference in the disease-free survival time between the two groups (χ 2 = 0.211, P = 0.646). CONCLUSION: These data should be processed using the PSM method in a non-randomized controlled trial (non-RCT) study. It is safe and feasible for patients with gastric GISTs up to 5 cm in size or located in the gastroesophageal junction to be treated with laparoscopic surgery.

Safety analysis of laparoscopic endoscopic cooperative surgery versus endoscopic submucosal dissection for selected gastric gastrointestinal stromal tumors: a propensity score-matched study.

BACKGROUND: Laparoscopic endoscopic cooperative surgery (LECS) is a safe alternative to endoscopic submucosal dissection (ESD) for select gastric gastrointestinal stromal tumors (GISTs) that are <2 cm in size. To date, there have been no randomized studies comparing the feasibility of these two techniques. Therefore, we compared their feasibility and safety using the propensity score matching method in this study. METHODS: This was a single-center, retrospective, propensity score-matched study of patients who underwent resection of selected gastric GISTs between 2004 and 2014. All patients underwent curative resection for pathologically diagnosed small gastric GISTs. The primary aim was to determine intraoperative complications and postoperative courses. To overcome selection biases, we performed a 1:1 match using five covariates, including age, gender, body mass index, Charlson comorbidity index, and tumor location, to generate propensity scores. RESULTS: In total, 32 patients treated with LECS and 102 patients treated with ESD were balanced into 30 pairs. The rate of intraoperative complications was significantly lower in the LECS group than in the ESD group (P = 0.029). LECS patients had less intraoperative bleeding than did ESD patients (15.0 ml [range 9.5-50.0 ml] vs. 43.5 ml [range 22.3-56.0 ml], P = 0.004). The two groups had similar postoperative courses. There was no difference in the reoperation rate between the two groups (P = 0.112). The ESD group had a shorter operating time than did the LECS group (41.5 min vs. 96.5 min, P < 0.001). However, during a follow-up of 57.9 (±28.9) months, the recurrence rate did not differ significantly between the two groups (0.0 vs. 6.7 %, respectively; P = 0.256). CONCLUSIONS: LECS for selected gastric GIST patients is feasible and is associated with a better intraoperative outcome and an equal postoperative course compared with the results of ESD.

Prognostic impact of lymph node skip metastasis in Stage III colorectal cancer.

AIM: The aim of this study was to evaluate the prognostic impact of lymph node skip metastasis (LNSM) in patients with Stage III colorectal cancer. METHOD: Between April 2003 and December 2014, a total of 41 patients with lymph node skip metastasis (skip+) were compared with 86 patients with pericolic lymph node metastases [lymph node distribution (LND)1] and 57 patients with intermediate and/or main lymph node metastasis (LND2+3). All patients had radical D3 lymphadenectomy, performed either laparoscopically or as open surgery. RESULTS: The frequency of pT1-2 stage cancer was significantly higher in the skip+ group than in the LND1 group (26.8% vs 5.8%, P = 0.001). The number of metastatic lymph nodes in the skip+ group was lower than in the LND2+3 group (1.9 ± 1.5 vs 6.5 ± 6.0, P < 0.001). The 3-year disease-free survival (DFS) of the skip+, LND1 and LND2+3 groups was 64.8%, 69.7% and 40.1%, respectively (P = 0.008). The 3-year systemic recurrence rates of the skip+, LND1 and LND2+3 groups were 30.2%, 20.3% and 48.1%, respectively; (P = 0.002). Cox regression analysis revealed that preoperative carcinoembryonic antigen (CEA) of ≥ 5 ng/ml [hazard ratio (HR) = 2.2, P = 0.029], poor differentiation (HR = 3.8, P = 0.001) and skip+ (HR = 0.2, P = 0.021) were independently prognostic factors for DFS. CONCLUSION: The prognosis for the LND1-negative lymph node skip metastasis group was better than for the LND2+3 group and was comparable with that of the LND1 group after radical D3 lymphadenectomy.