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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...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2020
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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. |
format | Online Article Text |
id | pubmed-7141272 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
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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