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

• Published in: Annals of surgical oncology Vol. 21; no. 4; pp. 1153 - 1158
• Main Authors: Leapman, Michael S., Jibara, Ghalib, Tabrizian, Parissa, Franssen, Bernardo, Yang, Ming-Jim, Romanoff, Anya, Hall, Simon J., Palese, Michael, Sarpel, Umut, Hiotis, Spiros, Labow, Daniel
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.04.2014; Springer Nature B.V
• Subjects: Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Case-Control Studies; Chemotherapy, Cancer, Regional Perfusion; Combined Modality Therapy; Comorbidity; Female; Follow-Up Studies; Gastrectomy; Gastrointestinal Oncology; Humans; Hyperthermia, Induced; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - therapy; Neoplasm Staging; Oncology; Peritoneal Neoplasms - mortality; Peritoneal Neoplasms - secondary; Peritoneal Neoplasms - therapy; Prognosis; Prospective Studies; Retrospective Studies; Surgery; Surgical Oncology; Survival Rate; Urogenital Neoplasms - mortality; Urogenital Neoplasms - pathology; Urogenital Neoplasms - therapy; Peritoneal Cancer Index; Partial Cystectomy; Urinary Fistula; Pelvic Exenteration; Peritoneal Carcinomatosis
• ISSN: 1068-9265; 1534-4681; 1534-4681
• DOI: 10.1245/s10434-013-3393-8

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.