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Impact of Neoadjuvant Chemotherapy on the Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases: A Multi-Institutional Retrospective Review

Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with improved survival for patients with colorectal peritoneal metastases (CR-PM). However, the role of neoadjuvant chemotherapy (NAC) prior to CRS-HIPEC is poorly understood. A retrospective...

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Autores principales: Beal, Eliza W., Suarez-Kelly, Lorena P., Kimbrough, Charles W., Johnston, Fabian M., Greer, Jonathan, Abbott, Daniel E., Pokrzywa, Courtney, Raoof, Mustafa, Lee, Byrne, Grotz, Travis E., Leiting, Jennifer L., Fournier, Keith, Lee, Andrew J., Dineen, Sean P., Powers, Benjamin, Veerapong, Jula, Baumgartner, Joel M., Clarke, Callisia, Mogal, Harveshp, Russell, Marti C., Zaidi, Mohammed Y., Patel, Sameer H., Dhar, Vikrom, Lambert, Laura, Hendrix, Ryan J., Hays, John, Abdel-Misih, Sherif, Cloyd, Jordan M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141272/
https://www.ncbi.nlm.nih.gov/pubmed/32164300
http://dx.doi.org/10.3390/jcm9030748
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author Beal, Eliza W.
Suarez-Kelly, Lorena P.
Kimbrough, Charles W.
Johnston, Fabian M.
Greer, Jonathan
Abbott, Daniel E.
Pokrzywa, Courtney
Raoof, Mustafa
Lee, Byrne
Grotz, Travis E.
Leiting, Jennifer L.
Fournier, Keith
Lee, Andrew J.
Dineen, Sean P.
Powers, Benjamin
Veerapong, Jula
Baumgartner, Joel M.
Clarke, Callisia
Mogal, Harveshp
Russell, Marti C.
Zaidi, Mohammed Y.
Patel, Sameer H.
Dhar, Vikrom
Lambert, Laura
Hendrix, Ryan J.
Hays, John
Abdel-Misih, Sherif
Cloyd, Jordan M.
author_facet Beal, Eliza W.
Suarez-Kelly, Lorena P.
Kimbrough, Charles W.
Johnston, Fabian M.
Greer, Jonathan
Abbott, Daniel E.
Pokrzywa, Courtney
Raoof, Mustafa
Lee, Byrne
Grotz, Travis E.
Leiting, Jennifer L.
Fournier, Keith
Lee, Andrew J.
Dineen, Sean P.
Powers, Benjamin
Veerapong, Jula
Baumgartner, Joel M.
Clarke, Callisia
Mogal, Harveshp
Russell, Marti C.
Zaidi, Mohammed Y.
Patel, Sameer H.
Dhar, Vikrom
Lambert, Laura
Hendrix, Ryan J.
Hays, John
Abdel-Misih, Sherif
Cloyd, Jordan M.
author_sort Beal, Eliza W.
collection PubMed
description Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with improved survival for patients with colorectal peritoneal metastases (CR-PM). However, the role of neoadjuvant chemotherapy (NAC) prior to CRS-HIPEC is poorly understood. A retrospective review of adult patients with CR-PM who underwent CRS+/-HIPEC from 2000–2017 was performed. Among 298 patients who underwent CRS+/-HIPEC, 196 (65.8%) received NAC while 102 (34.2%) underwent surgery first (SF). Patients who received NAC had lower peritoneal cancer index score (12.1 + 7.9 vs. 14.3 + 8.5, p = 0.034). There was no significant difference in grade III/IV complications (22.4% vs. 16.7%, p = 0.650), readmission (32.3% vs. 23.5%, p = 0.114), or 30-day mortality (1.5% vs. 2.9%, p = 0.411) between groups. NAC patients experienced longer overall survival (OS) (median 32.7 vs. 22.0 months, p = 0.044) but similar recurrence-free survival (RFS) (median 13.8 vs. 13.0 months, p = 0.456). After controlling for confounding factors, NAC was not independently associated with improved OS (OR 0.80) or RFS (OR 1.04). Among patients who underwent CRS+/-HIPEC for CR-PM, the use of NAC was associated with improved OS that did not persist on multivariable analysis. However, NAC prior to CRS+/-HIPEC was a safe and feasible strategy for CR-PM, which may aid in the appropriate selection of patients for aggressive cytoreductive surgery.
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spelling pubmed-71412722020-04-10 Impact of Neoadjuvant Chemotherapy on the Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases: A Multi-Institutional Retrospective Review Beal, Eliza W. Suarez-Kelly, Lorena P. Kimbrough, Charles W. Johnston, Fabian M. Greer, Jonathan Abbott, Daniel E. Pokrzywa, Courtney Raoof, Mustafa Lee, Byrne Grotz, Travis E. Leiting, Jennifer L. Fournier, Keith Lee, Andrew J. Dineen, Sean P. Powers, Benjamin Veerapong, Jula Baumgartner, Joel M. Clarke, Callisia Mogal, Harveshp Russell, Marti C. Zaidi, Mohammed Y. Patel, Sameer H. Dhar, Vikrom Lambert, Laura Hendrix, Ryan J. Hays, John Abdel-Misih, Sherif Cloyd, Jordan M. J Clin Med Article Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with improved survival for patients with colorectal peritoneal metastases (CR-PM). However, the role of neoadjuvant chemotherapy (NAC) prior to CRS-HIPEC is poorly understood. A retrospective review of adult patients with CR-PM who underwent CRS+/-HIPEC from 2000–2017 was performed. Among 298 patients who underwent CRS+/-HIPEC, 196 (65.8%) received NAC while 102 (34.2%) underwent surgery first (SF). Patients who received NAC had lower peritoneal cancer index score (12.1 + 7.9 vs. 14.3 + 8.5, p = 0.034). There was no significant difference in grade III/IV complications (22.4% vs. 16.7%, p = 0.650), readmission (32.3% vs. 23.5%, p = 0.114), or 30-day mortality (1.5% vs. 2.9%, p = 0.411) between groups. NAC patients experienced longer overall survival (OS) (median 32.7 vs. 22.0 months, p = 0.044) but similar recurrence-free survival (RFS) (median 13.8 vs. 13.0 months, p = 0.456). After controlling for confounding factors, NAC was not independently associated with improved OS (OR 0.80) or RFS (OR 1.04). Among patients who underwent CRS+/-HIPEC for CR-PM, the use of NAC was associated with improved OS that did not persist on multivariable analysis. However, NAC prior to CRS+/-HIPEC was a safe and feasible strategy for CR-PM, which may aid in the appropriate selection of patients for aggressive cytoreductive surgery. MDPI 2020-03-10 /pmc/articles/PMC7141272/ /pubmed/32164300 http://dx.doi.org/10.3390/jcm9030748 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Beal, Eliza W.
Suarez-Kelly, Lorena P.
Kimbrough, Charles W.
Johnston, Fabian M.
Greer, Jonathan
Abbott, Daniel E.
Pokrzywa, Courtney
Raoof, Mustafa
Lee, Byrne
Grotz, Travis E.
Leiting, Jennifer L.
Fournier, Keith
Lee, Andrew J.
Dineen, Sean P.
Powers, Benjamin
Veerapong, Jula
Baumgartner, Joel M.
Clarke, Callisia
Mogal, Harveshp
Russell, Marti C.
Zaidi, Mohammed Y.
Patel, Sameer H.
Dhar, Vikrom
Lambert, Laura
Hendrix, Ryan J.
Hays, John
Abdel-Misih, Sherif
Cloyd, Jordan M.
Impact of Neoadjuvant Chemotherapy on the Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases: A Multi-Institutional Retrospective Review
title Impact of Neoadjuvant Chemotherapy on the Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases: A Multi-Institutional Retrospective Review
title_full Impact of Neoadjuvant Chemotherapy on the Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases: A Multi-Institutional Retrospective Review
title_fullStr Impact of Neoadjuvant Chemotherapy on the Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases: A Multi-Institutional Retrospective Review
title_full_unstemmed Impact of Neoadjuvant Chemotherapy on the Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases: A Multi-Institutional Retrospective Review
title_short Impact of Neoadjuvant Chemotherapy on the Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases: A Multi-Institutional Retrospective Review
title_sort impact of neoadjuvant chemotherapy on the outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: a multi-institutional retrospective review
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141272/
https://www.ncbi.nlm.nih.gov/pubmed/32164300
http://dx.doi.org/10.3390/jcm9030748
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