Cargando…
Is Routine Omentectomy a Necessary Component of Cytoreductive Surgery and HIPEC?
BACKGROUND: Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal metastases traditionally includes omentectomy, even in the absence of visible omental metastases. We sought to determine the rate of occult histologic omental metastasis (OHOM), e...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9807473/ https://www.ncbi.nlm.nih.gov/pubmed/36305990 http://dx.doi.org/10.1245/s10434-022-12714-7 |
_version_ | 1784862727120879616 |
---|---|
author | Khan, Sohini Doan, Nguyen-Huong Hosseini, Mojgan Kelly, Kaitlyn Veerapong, Jula Lowy, Andrew M. Baumgartner, Joel |
author_facet | Khan, Sohini Doan, Nguyen-Huong Hosseini, Mojgan Kelly, Kaitlyn Veerapong, Jula Lowy, Andrew M. Baumgartner, Joel |
author_sort | Khan, Sohini |
collection | PubMed |
description | BACKGROUND: Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal metastases traditionally includes omentectomy, even in the absence of visible omental metastases. We sought to determine the rate of occult histologic omental metastasis (OHOM), evaluate morbidity with omentectomy, and examine the rate of omental recurrence among patients undergoing CRS-HIPEC. METHODS: All CRS-HIPEC procedures from August 2007 to August 2020 were included in this single-center, retrospective, cohort study. Procedures were divided into those that included greater omentectomy (OM) and those that did not (NOM). The incidence of OHOM was evaluated specifically among the OM group with a grossly normal omentum. Multivariate regression analyses were performed to evaluate return of bowel function, ileus, and morbidity in the OM and NOM groups. RESULTS: Among 683 CRS-HIPEC procedures, 578 (84.6%) included omentectomy and 105 (15.4%) did not. The OM group had higher operative time, blood loss, peritoneal cancer index, number of visceral resections, and length of stay. In the OM group, 72 (12.5%) patients had a grossly normal omentum, and 23 (31.9%) of these had OHOM. Risk-adjusted return of bowel function, ileus, and 60-day complications were no different in the OM and NOM groups. Among 43 patients with residual omentum, 24 (55.8%) recurred, including 9 (20.9%) with omental recurrence. CONCLUSIONS: Histologically occult metastasis was present in one-third of patients undergoing omentectomy during CRS-HIPEC. Omentectomy did not increase the rate of overall morbidity, and one-fifth of patients with residual omentum later developed omental recurrence. Thus, omentectomy is warranted in the absence of gross metastases during CRS-HIPEC. |
format | Online Article Text |
id | pubmed-9807473 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-98074732023-01-04 Is Routine Omentectomy a Necessary Component of Cytoreductive Surgery and HIPEC? Khan, Sohini Doan, Nguyen-Huong Hosseini, Mojgan Kelly, Kaitlyn Veerapong, Jula Lowy, Andrew M. Baumgartner, Joel Ann Surg Oncol Peritoneal Surface Malignancy BACKGROUND: Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal metastases traditionally includes omentectomy, even in the absence of visible omental metastases. We sought to determine the rate of occult histologic omental metastasis (OHOM), evaluate morbidity with omentectomy, and examine the rate of omental recurrence among patients undergoing CRS-HIPEC. METHODS: All CRS-HIPEC procedures from August 2007 to August 2020 were included in this single-center, retrospective, cohort study. Procedures were divided into those that included greater omentectomy (OM) and those that did not (NOM). The incidence of OHOM was evaluated specifically among the OM group with a grossly normal omentum. Multivariate regression analyses were performed to evaluate return of bowel function, ileus, and morbidity in the OM and NOM groups. RESULTS: Among 683 CRS-HIPEC procedures, 578 (84.6%) included omentectomy and 105 (15.4%) did not. The OM group had higher operative time, blood loss, peritoneal cancer index, number of visceral resections, and length of stay. In the OM group, 72 (12.5%) patients had a grossly normal omentum, and 23 (31.9%) of these had OHOM. Risk-adjusted return of bowel function, ileus, and 60-day complications were no different in the OM and NOM groups. Among 43 patients with residual omentum, 24 (55.8%) recurred, including 9 (20.9%) with omental recurrence. CONCLUSIONS: Histologically occult metastasis was present in one-third of patients undergoing omentectomy during CRS-HIPEC. Omentectomy did not increase the rate of overall morbidity, and one-fifth of patients with residual omentum later developed omental recurrence. Thus, omentectomy is warranted in the absence of gross metastases during CRS-HIPEC. Springer International Publishing 2022-10-28 2023 /pmc/articles/PMC9807473/ /pubmed/36305990 http://dx.doi.org/10.1245/s10434-022-12714-7 Text en © This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Peritoneal Surface Malignancy Khan, Sohini Doan, Nguyen-Huong Hosseini, Mojgan Kelly, Kaitlyn Veerapong, Jula Lowy, Andrew M. Baumgartner, Joel Is Routine Omentectomy a Necessary Component of Cytoreductive Surgery and HIPEC? |
title | Is Routine Omentectomy a Necessary Component of Cytoreductive Surgery and HIPEC? |
title_full | Is Routine Omentectomy a Necessary Component of Cytoreductive Surgery and HIPEC? |
title_fullStr | Is Routine Omentectomy a Necessary Component of Cytoreductive Surgery and HIPEC? |
title_full_unstemmed | Is Routine Omentectomy a Necessary Component of Cytoreductive Surgery and HIPEC? |
title_short | Is Routine Omentectomy a Necessary Component of Cytoreductive Surgery and HIPEC? |
title_sort | is routine omentectomy a necessary component of cytoreductive surgery and hipec? |
topic | Peritoneal Surface Malignancy |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9807473/ https://www.ncbi.nlm.nih.gov/pubmed/36305990 http://dx.doi.org/10.1245/s10434-022-12714-7 |
work_keys_str_mv | AT khansohini isroutineomentectomyanecessarycomponentofcytoreductivesurgeryandhipec AT doannguyenhuong isroutineomentectomyanecessarycomponentofcytoreductivesurgeryandhipec AT hosseinimojgan isroutineomentectomyanecessarycomponentofcytoreductivesurgeryandhipec AT kellykaitlyn isroutineomentectomyanecessarycomponentofcytoreductivesurgeryandhipec AT veerapongjula isroutineomentectomyanecessarycomponentofcytoreductivesurgeryandhipec AT lowyandrewm isroutineomentectomyanecessarycomponentofcytoreductivesurgeryandhipec AT baumgartnerjoel isroutineomentectomyanecessarycomponentofcytoreductivesurgeryandhipec |