Hendrix, Ryan J
Mayo Clinic
Department of Surgery, Division of Surgical Oncology, University of Minnesota, Minneapolis, Minnesota, USA.
Citations 2
A novel preoperative risk score to optimize patient selection for performing concomitant liver resection with cytoreductive surgery/HIPEC
Lee, Rachel , Turgeon, Michael K. , Zaidi, Mohammad Y. , Kimbrough, Charles W. , Leiting, Jennifer L. , Grotz, Travis E. , Powers, Benjamin D. , Baumgartner, Joel , Veerapong, Jula , Hendrix, Ryan J. , Lambert, Laura , Pokrzywa, Courtney , Abbott, Daniel E. , LaRocca, Christopher J. , Raoof, Mustafa , Staley, Charles A., Cloyd, Jordan M. , Leiting, Jennifer L , Grotz, Travis E , Powers, Benjamin , Mogal, Harveshp , Clarke, Callisia N , Patel, Sameer H , Hendrix, Ryan J , Raoof, Mustafa , Gamboa, Adriana Carolina , Lee, Andrew , Fournier, Keith F. , Dineen, Seán , Clarke, Callisia N. , Wilson, Gregory C. , Greer, Jonathan B. , Johnston, Fabian M , Maithel, Shishir K , Russell, Maria Citarella
Journal of Surgical Oncology | October 1, 2020 | Volume: 123 | Issue: 1 | Pages: 187-195
AbstractBackgroundWhile parenchymal hepatic metastases were previously considered a contraindication to cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC), liver resection (LR) is increasingly performed with CRS/HIPEC.MethodsPatients from the US HIPEC Collaborative (2000–2017) with invasive appendiceal or colorectal adenocarcinoma undergoing primary, curative intent CRS/HIPEC with CC0‐1 resection were included. LR was defined as a formal parenchymal resection. Primary endpoints were postoperative complications and overall survival (OS).ResultsA total of 658 patients were included. About 83 (15%) underwent LR of colorectal (58%) or invasive appendiceal (42%) metastases. LR patients had more complications (81% vs. 60%; p = .001), greater number of complications (2.3 vs. 1.5; p < .001) per patient and required more reoperations (22% vs. 11%; p = .007) and readmissions (39% vs. 25%; p = .014) than non‐LR patients. LR patients had decreased OS (2‐year OS 62% vs. 79%, p < .001), even when accounting for peritoneal carcinomatosis index and histology type. Preoperative factors associated with decreased OS on multivariable analysis in LR patients included age < 60 years (HR, 3.61; 95% CI, 1.10–11.81), colorectal histology (HR, 3.84; 95% CI, 1.69–12.65), and multiple liver tumors (HR, 3.45; 95% CI, 1.21–9.85) (all p < .05). When assigning one point for each factor, there was an incremental decrease in 2‐year survival as the risk score increased from 0 to 3 (0: 100%; 1: 91%; 2: 58%; 3: 0%).ConclusionsAs CRS/HIPEC + LR has become more common, we created a simple risk score to stratify patients considered for CRS/HIPEC + LR. These data aid in striking the balance between an increased perioperative complication profile with the potential for improvement in OS.
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.