title: Extreme cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Outcomes from a single tertiary center.
abstract: BACKGROUND
  Multivisceral resection as part of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) may be required in order to achieve optimal debulking. This study aimed to assess perioperative and long-term outcomes of the most extensive CRS/HIPEC procedures.
  
  
  METHODS
  All patients who underwent CRS/HIPEC at our institution between March 2007 and July 2014 were retrospectively reviewed. Patients undergoing extreme cytoreduction (n = 50), defined as a resection of ≥5 organs or ≥3 bowel anastomoses, were compared with patients who underwent less extensive procedures (n = 219).
  
  
  RESULTS
  Complete cytoreduction (CC score ≤1) was achieved in 76% of the extreme CRS/HIPEC group, which included patients with colorectal cancer (CRC, n = 17), appendiceal adenocarcinoma (n = 20), gastric cancer (n = 6), and low-grade appendiceal neoplasm (n = 3). When compared with other patients undergoing CRS/HIPEC, the extreme CRS/HIPEC group had higher median PCI score, increased intraoperative blood loss, longer duration of surgery and longer hospital stay (all p values < 0.001). Major 30-day morbidity was significantly higher among the extreme CRS/HIPEC group (34% vs. 17.4%, p = 0.008) and there was also a trend towards higher 90-day mortality (12% vs. 5.1%, p = 0.07). Median disease free survival and overall survival in CRC patients undergoing extreme CRS/HIPEC was poorer (4.1 vs. 14.3 months, p = 0.01 and 10.1 vs. 43.8 months, p < 0.001, respectively). Extreme CRS/HIPEC was found to independently predict decreased overall survival in CRC patients.
  
  
  CONCLUSIONS
  Extreme multivisceral resection as part of CRS/HIPEC is associated with higher major morbidity and inferior oncologic outcomes; therefore CRS/HIPEC provides the best outcomes in patients with fewer organs involved.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Yaniv
authors.initials: Y
authors.lastname: Berger
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Samantha
authors.initials: S
authors.lastname: Aycart
authors.affiliation: Department of Preventive Medicine, Mount Sinai School of Medicine, New York, NY, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Mandeli
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Marina
authors.initials: M
authors.lastname: Heskel
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Umut
authors.initials: U
authors.lastname: Sarpel
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Mount Sinai Medical Center, New York, NY, USA. Electronic address: daniel.labow@mountsinai.org.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Labow
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001063:Appendiceal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate
keywords: Cytoreductive surgery; Hyperthermic intraperitoneal chemotherapy; Multi-organ; Multivisceral