Diaphragmatic Peritoneal Stripping Versus Full-Thickness Resection in CRS/HIPEC: Is There a Difference?
Background Pleural recurrence after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is rare and poorly delineated. Specifically, data are limited on the effect that diaphragmatic peritoneal stripping versus full-thickness resection has on the nature of ipsilateral p...
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| Veröffentlicht in: | Annals of surgical oncology 2020, Vol.27 (1), p.250-258 |
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| creator | Sullivan, Brianne J. Bekhor, Eliahu Y. Carpiniello, Matthew Leigh, Natasha L. Pletcher, Eric R. Solomon, Daniel Magge, Deepa R. Sarpel, Umut Labow, Daniel M. Golas, Benjamin J. |
| description | Background
Pleural recurrence after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is rare and poorly delineated. Specifically, data are limited on the effect that diaphragmatic peritoneal stripping versus full-thickness resection has on the nature of ipsilateral pleural recurrence and postoperative morbidity.
Methods
Patients with peritoneal carcinomatosis who underwent CRS/HIPEC were included from a prospectively maintained database. The patients were divided into three cohorts based on surgical management of the diaphragm as follows: diaphragm-stripping (DS) cohort, full-thickness resection (FTR) cohort, and no diaphragm manipulation (ND) cohort. Postoperative morbidity and incidence of ipsilateral pleural recurrence were evaluated. All diaphragmatic defects were closed before abdominal chemoperfusion.
Results
The inclusion criteria were met by 409 CRS/HIPEC procedures: 66 in DS, 122 in FTR, and 238 in ND. Ipsilateral pleural recurrence rates did not differ significantly between the three cohorts (DS 6%, FTR 3%, ND 3%;
p
= 0.470). Postoperative respiratory complications and overall morbidity were significantly greater for the patients who underwent diaphragmatic disruption (stripping and/or resection) than for the patients who did not (
p
≤ 0.0001), but the two groups did not differ in terms of 30-day mortality. However, comparison of FTR with DS showed no impact on major morbidity or pleural recurrence.
Conclusion
Although patients undergoing surgical manipulation of the diaphragm during CRS/HIPEC experienced significantly greater morbidity, diaphragmatic stripping did not differ from full-thickness resection in terms of grades 3 and 4 complications or incidence of ipsilateral pleural recurrences. When deemed necessary to achieve complete cytoreduction, full-thickness diaphragmatic resection should be undertaken. In addition, the data support the observation that definitive repair of the diaphragmatic defect before abdominal chemoperfusion does not adversely influence ipsilateral pleural recurrence. |
| doi_str_mv | 10.1245/s10434-019-07797-8 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2288006119</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2287210927</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-70f1fa4ce248fe1c1205cd5dbb555340f8c30f46d5e4722604059f133c05a20e3</originalsourceid><addsrcrecordid>eNp9kU9vEzEQxS0EoqXwBTggS1y4LB3_W3u5IJS2NFIlqjZwtRxnnLhsvFt798C3xyUFJA6c_GT_5o1nHiGvGbxnXKrTwkAK2QDrGtC60415Qo6ZqleyNexp1dCapuOtOiIvSrkDYFqAek6OBFPAgZljsj2Lbtxlt927KXp6jTlOQ0LX09spx3GMaUu_YS5zoRdz3zerXfTfE5ZCb7Cgn-KQaEx0cXN7erm8Pl98oMtCVzvMSB09iyFUlTx-fEmeBdcXfPV4npCvF-erxWVz9eXzcvHpqvFCq6nREFhw0iOXJiDzjIPyG7VZr5Wqg0EwXkCQ7Uah1Jy3IEF1gQnhQTkOKE7Iu4PvmIf7Gctk97F47HuXcJiL5dwYgJaxrqJv_0Hvhjmn-rsHSnMGHdeV4gfK56GUjMGOOe5d_mEZ2IcY7CEGW2Owv2Kwpha9ebSe13vc_Cn5vfcKiANQ6lPaYv7b-z-2PwHBf5C0</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2287210927</pqid></control><display><type>article</type><title>Diaphragmatic Peritoneal Stripping Versus Full-Thickness Resection in CRS/HIPEC: Is There a Difference?</title><source>SpringerLink Journals - AutoHoldings</source><creator>Sullivan, Brianne J. ; Bekhor, Eliahu Y. ; Carpiniello, Matthew ; Leigh, Natasha L. ; Pletcher, Eric R. ; Solomon, Daniel ; Magge, Deepa R. ; Sarpel, Umut ; Labow, Daniel M. ; Golas, Benjamin J.</creator><creatorcontrib>Sullivan, Brianne J. ; Bekhor, Eliahu Y. ; Carpiniello, Matthew ; Leigh, Natasha L. ; Pletcher, Eric R. ; Solomon, Daniel ; Magge, Deepa R. ; Sarpel, Umut ; Labow, Daniel M. ; Golas, Benjamin J.</creatorcontrib><description>Background
Pleural recurrence after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is rare and poorly delineated. Specifically, data are limited on the effect that diaphragmatic peritoneal stripping versus full-thickness resection has on the nature of ipsilateral pleural recurrence and postoperative morbidity.
Methods
Patients with peritoneal carcinomatosis who underwent CRS/HIPEC were included from a prospectively maintained database. The patients were divided into three cohorts based on surgical management of the diaphragm as follows: diaphragm-stripping (DS) cohort, full-thickness resection (FTR) cohort, and no diaphragm manipulation (ND) cohort. Postoperative morbidity and incidence of ipsilateral pleural recurrence were evaluated. All diaphragmatic defects were closed before abdominal chemoperfusion.
Results
The inclusion criteria were met by 409 CRS/HIPEC procedures: 66 in DS, 122 in FTR, and 238 in ND. Ipsilateral pleural recurrence rates did not differ significantly between the three cohorts (DS 6%, FTR 3%, ND 3%;
p
= 0.470). Postoperative respiratory complications and overall morbidity were significantly greater for the patients who underwent diaphragmatic disruption (stripping and/or resection) than for the patients who did not (
p
≤ 0.0001), but the two groups did not differ in terms of 30-day mortality. However, comparison of FTR with DS showed no impact on major morbidity or pleural recurrence.
Conclusion
Although patients undergoing surgical manipulation of the diaphragm during CRS/HIPEC experienced significantly greater morbidity, diaphragmatic stripping did not differ from full-thickness resection in terms of grades 3 and 4 complications or incidence of ipsilateral pleural recurrences. When deemed necessary to achieve complete cytoreduction, full-thickness diaphragmatic resection should be undertaken. In addition, the data support the observation that definitive repair of the diaphragmatic defect before abdominal chemoperfusion does not adversely influence ipsilateral pleural recurrence.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-019-07797-8</identifier><identifier>PMID: 31502018</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Chemotherapy ; Diaphragm ; Gastric cancer ; Knee ; Medicine ; Medicine & Public Health ; Morbidity ; Oncology ; Peritoneal Surface Malignancy ; Peritoneum ; Surgery ; Surgical Oncology</subject><ispartof>Annals of surgical oncology, 2020, Vol.27 (1), p.250-258</ispartof><rights>Society of Surgical Oncology 2019</rights><rights>Annals of Surgical Oncology is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-70f1fa4ce248fe1c1205cd5dbb555340f8c30f46d5e4722604059f133c05a20e3</citedby><cites>FETCH-LOGICAL-c375t-70f1fa4ce248fe1c1205cd5dbb555340f8c30f46d5e4722604059f133c05a20e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-019-07797-8$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-019-07797-8$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31502018$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sullivan, Brianne J.</creatorcontrib><creatorcontrib>Bekhor, Eliahu Y.</creatorcontrib><creatorcontrib>Carpiniello, Matthew</creatorcontrib><creatorcontrib>Leigh, Natasha L.</creatorcontrib><creatorcontrib>Pletcher, Eric R.</creatorcontrib><creatorcontrib>Solomon, Daniel</creatorcontrib><creatorcontrib>Magge, Deepa R.</creatorcontrib><creatorcontrib>Sarpel, Umut</creatorcontrib><creatorcontrib>Labow, Daniel M.</creatorcontrib><creatorcontrib>Golas, Benjamin J.</creatorcontrib><title>Diaphragmatic Peritoneal Stripping Versus Full-Thickness Resection in CRS/HIPEC: Is There a Difference?</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>Background
Pleural recurrence after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is rare and poorly delineated. Specifically, data are limited on the effect that diaphragmatic peritoneal stripping versus full-thickness resection has on the nature of ipsilateral pleural recurrence and postoperative morbidity.
Methods
Patients with peritoneal carcinomatosis who underwent CRS/HIPEC were included from a prospectively maintained database. The patients were divided into three cohorts based on surgical management of the diaphragm as follows: diaphragm-stripping (DS) cohort, full-thickness resection (FTR) cohort, and no diaphragm manipulation (ND) cohort. Postoperative morbidity and incidence of ipsilateral pleural recurrence were evaluated. All diaphragmatic defects were closed before abdominal chemoperfusion.
Results
The inclusion criteria were met by 409 CRS/HIPEC procedures: 66 in DS, 122 in FTR, and 238 in ND. Ipsilateral pleural recurrence rates did not differ significantly between the three cohorts (DS 6%, FTR 3%, ND 3%;
p
= 0.470). Postoperative respiratory complications and overall morbidity were significantly greater for the patients who underwent diaphragmatic disruption (stripping and/or resection) than for the patients who did not (
p
≤ 0.0001), but the two groups did not differ in terms of 30-day mortality. However, comparison of FTR with DS showed no impact on major morbidity or pleural recurrence.
Conclusion
Although patients undergoing surgical manipulation of the diaphragm during CRS/HIPEC experienced significantly greater morbidity, diaphragmatic stripping did not differ from full-thickness resection in terms of grades 3 and 4 complications or incidence of ipsilateral pleural recurrences. When deemed necessary to achieve complete cytoreduction, full-thickness diaphragmatic resection should be undertaken. In addition, the data support the observation that definitive repair of the diaphragmatic defect before abdominal chemoperfusion does not adversely influence ipsilateral pleural recurrence.</description><subject>Chemotherapy</subject><subject>Diaphragm</subject><subject>Gastric cancer</subject><subject>Knee</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Morbidity</subject><subject>Oncology</subject><subject>Peritoneal Surface Malignancy</subject><subject>Peritoneum</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kU9vEzEQxS0EoqXwBTggS1y4LB3_W3u5IJS2NFIlqjZwtRxnnLhsvFt798C3xyUFJA6c_GT_5o1nHiGvGbxnXKrTwkAK2QDrGtC60415Qo6ZqleyNexp1dCapuOtOiIvSrkDYFqAek6OBFPAgZljsj2Lbtxlt927KXp6jTlOQ0LX09spx3GMaUu_YS5zoRdz3zerXfTfE5ZCb7Cgn-KQaEx0cXN7erm8Pl98oMtCVzvMSB09iyFUlTx-fEmeBdcXfPV4npCvF-erxWVz9eXzcvHpqvFCq6nREFhw0iOXJiDzjIPyG7VZr5Wqg0EwXkCQ7Uah1Jy3IEF1gQnhQTkOKE7Iu4PvmIf7Gctk97F47HuXcJiL5dwYgJaxrqJv_0Hvhjmn-rsHSnMGHdeV4gfK56GUjMGOOe5d_mEZ2IcY7CEGW2Owv2Kwpha9ebSe13vc_Cn5vfcKiANQ6lPaYv7b-z-2PwHBf5C0</recordid><startdate>2020</startdate><enddate>2020</enddate><creator>Sullivan, Brianne J.</creator><creator>Bekhor, Eliahu Y.</creator><creator>Carpiniello, Matthew</creator><creator>Leigh, Natasha L.</creator><creator>Pletcher, Eric R.</creator><creator>Solomon, Daniel</creator><creator>Magge, Deepa R.</creator><creator>Sarpel, Umut</creator><creator>Labow, Daniel M.</creator><creator>Golas, Benjamin J.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>2020</creationdate><title>Diaphragmatic Peritoneal Stripping Versus Full-Thickness Resection in CRS/HIPEC: Is There a Difference?</title><author>Sullivan, Brianne J. ; Bekhor, Eliahu Y. ; Carpiniello, Matthew ; Leigh, Natasha L. ; Pletcher, Eric R. ; Solomon, Daniel ; Magge, Deepa R. ; Sarpel, Umut ; Labow, Daniel M. ; Golas, Benjamin J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-70f1fa4ce248fe1c1205cd5dbb555340f8c30f46d5e4722604059f133c05a20e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Chemotherapy</topic><topic>Diaphragm</topic><topic>Gastric cancer</topic><topic>Knee</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Morbidity</topic><topic>Oncology</topic><topic>Peritoneal Surface Malignancy</topic><topic>Peritoneum</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sullivan, Brianne J.</creatorcontrib><creatorcontrib>Bekhor, Eliahu Y.</creatorcontrib><creatorcontrib>Carpiniello, Matthew</creatorcontrib><creatorcontrib>Leigh, Natasha L.</creatorcontrib><creatorcontrib>Pletcher, Eric R.</creatorcontrib><creatorcontrib>Solomon, Daniel</creatorcontrib><creatorcontrib>Magge, Deepa R.</creatorcontrib><creatorcontrib>Sarpel, Umut</creatorcontrib><creatorcontrib>Labow, Daniel M.</creatorcontrib><creatorcontrib>Golas, Benjamin J.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sullivan, Brianne J.</au><au>Bekhor, Eliahu Y.</au><au>Carpiniello, Matthew</au><au>Leigh, Natasha L.</au><au>Pletcher, Eric R.</au><au>Solomon, Daniel</au><au>Magge, Deepa R.</au><au>Sarpel, Umut</au><au>Labow, Daniel M.</au><au>Golas, Benjamin J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Diaphragmatic Peritoneal Stripping Versus Full-Thickness Resection in CRS/HIPEC: Is There a Difference?</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2020</date><risdate>2020</risdate><volume>27</volume><issue>1</issue><spage>250</spage><epage>258</epage><pages>250-258</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract>Background
Pleural recurrence after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is rare and poorly delineated. Specifically, data are limited on the effect that diaphragmatic peritoneal stripping versus full-thickness resection has on the nature of ipsilateral pleural recurrence and postoperative morbidity.
Methods
Patients with peritoneal carcinomatosis who underwent CRS/HIPEC were included from a prospectively maintained database. The patients were divided into three cohorts based on surgical management of the diaphragm as follows: diaphragm-stripping (DS) cohort, full-thickness resection (FTR) cohort, and no diaphragm manipulation (ND) cohort. Postoperative morbidity and incidence of ipsilateral pleural recurrence were evaluated. All diaphragmatic defects were closed before abdominal chemoperfusion.
Results
The inclusion criteria were met by 409 CRS/HIPEC procedures: 66 in DS, 122 in FTR, and 238 in ND. Ipsilateral pleural recurrence rates did not differ significantly between the three cohorts (DS 6%, FTR 3%, ND 3%;
p
= 0.470). Postoperative respiratory complications and overall morbidity were significantly greater for the patients who underwent diaphragmatic disruption (stripping and/or resection) than for the patients who did not (
p
≤ 0.0001), but the two groups did not differ in terms of 30-day mortality. However, comparison of FTR with DS showed no impact on major morbidity or pleural recurrence.
Conclusion
Although patients undergoing surgical manipulation of the diaphragm during CRS/HIPEC experienced significantly greater morbidity, diaphragmatic stripping did not differ from full-thickness resection in terms of grades 3 and 4 complications or incidence of ipsilateral pleural recurrences. When deemed necessary to achieve complete cytoreduction, full-thickness diaphragmatic resection should be undertaken. In addition, the data support the observation that definitive repair of the diaphragmatic defect before abdominal chemoperfusion does not adversely influence ipsilateral pleural recurrence.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>31502018</pmid><doi>10.1245/s10434-019-07797-8</doi><tpages>9</tpages></addata></record> |
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| subjects | Chemotherapy Diaphragm Gastric cancer Knee Medicine Medicine & Public Health Morbidity Oncology Peritoneal Surface Malignancy Peritoneum Surgery Surgical Oncology |
| title | Diaphragmatic Peritoneal Stripping Versus Full-Thickness Resection in CRS/HIPEC: Is There a Difference? |
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