Dineen, Sean P
Mayo Clinic
Department of Gastrointestinal Oncology and Oncologic Sciences, Moffitt Cancer Center, Morsani College of Medicine, Tampa, Florida, USA.
Citations 2
Influence of insurance status on the postoperative outcomes of cytoreductive surgery and HIPEC
Kubi, Boateng , Nudotor, Richard , Fackche, Nadege , Rowe, Julian , Cloyd, Jordan M. , Grotz, Travis E. , Dineen, Seán , Veerapong, Jula , Baumgartner, Joel , Dhar, Vikrom K. , Lambert, Laura , Abbott, Daniel E. , Pokrzywa, Courtney , Raoof, Mustafa , Lee, Byrne , Zaidi, Mohammad Y. , Grotz, Travis E , Dineen, Sean P , Clarke, Callisia N , Patel, Sameer H , Dhar, Vikrom , Abbott, Daniel E , Raoof, Mustafa , Zaidi, Mohammad Y , Maithel, Shishir K , Johnston, Fabian M , Ahmed, Ahmed , Fournier, Keith F. , Clarke, Callisia N. , Greer, Jonathan B.
Journal of Surgical Oncology | December 5, 2022 | Volume: 127 | Issue: 4 | Pages: 706-715
AbstractBackgroundCytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is increasingly performed for peritoneal surface malignancies but remains associated with significant morbidity. Scant research is available regarding the impact of insurance status on postoperative outcomes.MethodsPatients undergoing CRS/HIPEC between 2000 and 2017 at 12 participating sites in the US HIPEC Collaborative were identified. Univariate and multivariate analyses were used to compare the baseline characteristics, operative variables, and postoperative outcomes of patients with government, private, or no insurance.ResultsAmong 2268 patients, 699 (30.8%) had government insurance, 1453 (64.0%) had private, and 116 (5.1%) were uninsured. Patients with government insurance were older, more likely to be non‐white, and comorbid (p < 0.05). Patients with government (OR: 2.25, CI: 1.50−3.36, p < 0.001) and private (OR: 1.69, CI: 1.15−2.49, p = 0.008) insurance had an increased risk of complications on univariate analysis. There was no independent relationship on multivariate analysis. An American Society of Anesthesiologists score of 3 or 4, peritoneal carcinomatosis index score >15, completeness of cytoreduction score >1, and nonhome discharge were factors independently associated with a postoperative complication.ConclusionWhile there were differences in postoperative outcomes between the three insurance groups on univariate analysis, there was no independent association between insurance status and postoperative complications after CRS/HIPEC.
Impact of Neoadjuvant Chemotherapy on the Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases: A Multi-Institutional Retrospective Review
Suarez‐Kelly, Lorena P. , Kimbrough, Charles W. , Abbott, Daniel E. , Pokrzywa, Courtney , Raoof, Mustafa , Lee, Byrne , Grotz, Travis E. , Leiting, Jennifer L. , Dineen, Seán , Powers, Benjamin D. , Veerapong, Jula , Baumgartner, Joel , Russell, Marti C., Zaidi, M., Dhar, Vikrom K. , Lambert, Laura , Hendrix, Ryan J. , Abdel‐Misih, Sherif , Cloyd, Jordan M. , Suarez-Kelly, Lorena P , Pokrzywa, Courtney , Grotz, Travis E , Dineen, Sean P , Hendrix, Ryan J , Abdel-Misih, Sherif , Powers, Benjamin , Dhar, Vikrom , Beal, Eliza Wright , Johnston, Fabian M , Greer, Jonathan B. , Fournier, Keith F. , Lee, Andrew , Clarke, Callisia N. , Mogal, Harveshp , Zaidi, Mohammed Y., Patel, Sameer H , Hays, John L.
Journal of Clinical Medicine | March 12, 2020 | Volume: 9 | Issue: 3 | Pages: 748
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.